Berlin Heart EXCOR Pediatric VAD, Manual, Page: 143 / 250

Chapter 10 Implantation - anesthesia
10 Implantation - anesthesia
The following risk factors should be closely monitored for anesthetic and
hemodynamic management:
• right heart function during LVAD implantation
• coagulopathy
• renal insufficiency
• abnormal reactions to inotrope administration
• pulmonary hypertension
CAUTION
There should be an adequate supply of pre-matched stored blood,
fresh frozen plasma and platelet concentrates available for immediate
transfusion if required.
Keep blood product transfusions to a minimum. Blood transfusions may
lead to the development of antibodies, which are known to promote
coagulation and inflammatory response.
ADVICE
Medication for right ventricular afterload reduction should be available
for use in the operating room (nitric oxide NO, phosphodiesterase
inhibitor, prostaglandin, etc)
Auto-transfusion equipment (e. g. Cellsaver) should be available for
use in the operating room.
For patients with an LVAD, start ventilation with nitric oxide or
administer the appropriate medication to treat pulmonary hypertension
and reduce afterload for right ventricle 15 minutes before weaning from
the CPB. This can help to prevent or lower the risk of right ventricular
failure.
Monitoring procedure
Intraoperative monitoring should include the same monitoring procedures applied
during major cardiothoracic surgery:
• central venous line
• Swan-Ganz catheter (if appropriate)
• arterial line
• ECG
• pulse oximetry
• central temperature monitor
• urine catheter
Additional recommended monitoring procedures
• cardiac output calculation (if appropriate)
• intraoperative transesophageal echocardiogram (inflow cannula position, heart
valve function, intracardial shunts, volume status
• right heart function in case of LVAD
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