| Anesthesia management of a patient with a ventricular assist device for noncardiac surgery. | |
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MedLine Citation:
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PMID: 20472619 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Congestive heart failure represents a severe health condition with unfavourable long-term prognosis despite all the progress in pharmacological therapy of heart failure. Another therapeutic option is represented by mechanical cardiac support devices. Ventricular assist devices (VAD) constitute largest subgroup of these devices. Patients supported with VAD carry many considerations which are important for successful perioperative management of these patients for noncardiac surgery. The general perioperative considerations include consultation with VAD management personnel, detailed assessment of end-organ dysfunction before surgery, appropriate antibiotic prophylaxis, deactivation of implantable cardioverter-defibrillator for the time of surgical procedure, and the choice between general and regional anesthesia. Intraoperative monitoring depends primarily on the type of blood flow generated by VAD. For devices generating pulsatile blood flow, standard monitoring arrangements are needed. In the patients supported by devices which provide nonpulsatile blood flow, pulse oximetry and noninvasive blood pressure measurement are not reliable monitoring methods, and placement of intra-arterial catheter is warranted. In all the patients supported with VAD, transesophageal echocardiography is extremely useful method for monitoring the function of VAD itself, and in the case of univentricular VAD for monitoring the function of nonsupported cardiac ventricle. The most important issue in hemodynamic management of the patients with VAD is avoiding hypovolemia because it can cause inadequate VAD output with resulting low cardiac output and hypotension. All the patients with VAD need some degree of anticoagulation, and for noncardiac surgery the question of interrupting or decreasing the level of anticoagulation should be discussed among members of the caring team. |
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Authors:
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Hynek Riha; Ivan Netuka; Tomas Kotulak; Jiri Maly; Marian Pindak; Jiri Sedlacek; Jitka Lomova |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Seminars in cardiothoracic and vascular anesthesia Volume: 14 ISSN: 1940-5596 ISO Abbreviation: Semin Cardiothorac Vasc Anesth Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-05-17 Completed Date: 2010-08-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9807630 Medline TA: Semin Cardiothorac Vasc Anesth Country: United States |
Other Details:
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Languages: eng Pagination: 29-31 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. hynek.riha@ikem.cz |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anesthesia
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methods* Blood Pressure Determination / methods Echocardiography, Transesophageal Heart Failure / complications* Heart Ventricles / physiopathology, surgery Heart-Assist Devices* Humans Hypovolemia / prevention & control Intraoperative Care / methods Monitoring, Intraoperative / methods* Oximetry / methods Surgical Procedures, Operative / methods |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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