Anaesthetic Management and Cardiopulmonary Bypass
All patients receive their cardiac medications until the morning of
surgery. Oral intake is usually stopped 6 hours before LVAD
implantation. With glucose check-up every 2 hours and subcutaneous
insulin injections as needed, diabetic adult patients receive
intravenous fluids according to their body weight, starting at the
initiation of preoperative fasting (2,3). Sublingual lorazepam (2 mg) is
administered 2 hours before surgery to decrease anxiety. Anesthesia is
induced with either Ketamine iv bolus, Etomidate iv, Fentanyl iv and
Esmeron iv. After intubation, all patients were ventilated with 100%
oxygen. All invasive procedures are performed while the patients are
under deep anesthesia. Arterial blood pressure, central venous pressure,
electrocardiogram, saturation with pulse oximetry and rectal temperature
are routinely monitored during and after surgery (4). Anesthesia is
maintained in these cases with Sevoflurane, Propofol iv, Fentanyl iv and
Ketamine iv until the patients are fully awake in the postoperative
period. Ultra–fast-track anesthetic (5) management is not performed in
any of the patients, and all patients were transferred to the intensive
care unit while still under full sedation. Patients are extubated when
optimal cognitive, hemodynamic, and respiratory functions were achieved.
For postoperative pain management, paracetamol is usually administered.
Tranexamic acid (50 mg/kg) is used routinely to prevent bleeding
complications (4,5,6). Perioperative changes in temperature,
hemodynamics, and respiratory and metabolic parameters are recorded.
Alterations in hemoglobin and hematocrit, blood loss, and transfusion
requirement are monitored and documented. Standard hemoglobin
electrophoresis is performed to detect the concentrations of HbS and
HbA. By local protocol, all patients undergo LVAD implantation on
central extra-corporeal circulation support.