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Anesthetic management of a patient with a continuous-flow left ventricular assist device for video-assisted thoracoscopic surgery: a case report.
BMC Anesthesiology ( IF 2.2 ) Pub Date : 2020-01-20 , DOI: 10.1186/s12871-020-0933-1
Shihoko Iwata 1 , Sumire Yokokawa 1 , Mihoshi Sato 1 , Makoto Ozaki 1
Affiliation  

BACKGROUND As patients with left ventricular assist device (LVAD) have long expected survival, the incidence of noncardiac surgery in this patient population is increasing. Here, we present the anesthetic management of a patient with a continuous-flow LVAD who underwent video-assisted thoracic surgery (VATS). CASE PRESENTATION A 37-year-old man with LVAD was scheduled to undergo VATS because of repeated spontaneous pneumothorax. Generally, patients with these devices have marginal right heart function; therefore, it is important to avoid factors that worsen pulmonary vascular resistance (PVR). However, VATS requires one-lung ventilation (OLV) and it tends to cause increase in PVR, leading to right heart failure. In the present case, when the patient was set in a lateral decubitus position and progressive hypoxia was observed during OLV, transesophageal echocardiography demonstrated a dilated right ventricle and a temporally flattened interventricular septum, and the central venous pressure increased to approximately 20 mmHg. Because we anticipated deterioration of right heart function, dobutamine and milrinone were administered and/or respirator settings were changed to decrease PVR for maintaining LVAD performance. Finally, resection of a bulla was completed, and the patient was discharged in stable condition on postoperative day 37. CONCLUSIONS The anesthetic management of a patient with LVAD during VATS is challenging because the possible hemodynamic changes induced by hypoxia associated with OLV affect LVAD performance and right heart function. In our experience, VATS that requires OLV will be well tolerated in a patient with LVAD with preserved right heart function, and a multidisciplinary approach to maintain right heart function will be needed.

中文翻译:

电视胸腔镜手术连续流左室辅助装置患者的麻醉管理:一例。

背景技术随着具有左心室辅助装置(LVAD)的患者的长期预期生存,该患者人群中非心脏手术的发生率正在增加。在这里,我们介绍了接受电视胸腔手术(VATS)的连续流LVAD患者的麻醉管理。病例介绍由于反复自发性气胸,一名37岁LVAD的男性计划接受VATS。通常,使用这些设备的患者的右心功能不佳;因此,重要的是要避免导致肺血管阻力(PVR)恶化的因素。但是,VATS需要单肺通气(OLV),并且往往会导致PVR升高,从而导致右心衰竭。在本例中,当患者侧卧位并且在OLV期间观察到进行性缺氧时,经食道超声心动图检查显示右心室扩张和室间隔暂时变平,中心静脉压增至约20 mmHg。因为我们预计右心功能会恶化,所以多巴酚丁胺和米力农被给予和/或改变了呼吸器的设置以降低PVR以维持LVAD的表现。最后,完成了大疱切除术,术后第37天使患者稳定出院。结论VATS期间LVAD患者的麻醉处理具有挑战性,因为与OLV相关的低氧引起的血液动力学变化可能影响LVAD的性能和右心功能。根据我们的经验,LVD患者右心功能得以保留,可以很好地耐受需要OLV的VATS,
更新日期:2020-01-21
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