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Anesthesia management of a patient with left ventricular assist device for emergency open appendectomy: a case report.

OBJECTIVE
The objective of this case report is to describe the management of anesthesia of a patient with an LVAD that underwent an emergency open appendectomy. Literature regarding emergency anesthesia management of such patients is still limited. A search in the PubMed engine with the keywords "LVAD appendectomy anesthesia management" revealed no results.


CASE REPORT
The case regards a 54 years old male patient that received an LVAD implant 2 months before the current incident. Close monitoring was applied including invasive arterial pressure measurement. Etomidate was selected for induction thanks to its' insignificant hemodynamic effects. Careful titrated drug and liquids administration was applied to avoid hemodynamic destabilization. Anticoagulation treatment cannot be stopped in these patients, and there was no time for anticoagulation treatment changes. Two units of fresh frozen plasma were issued as preventive bleeding measures.


RESULTS
No hemodynamic destabilization (targeted MAP: 65-90 mmHg) and bleeding were registered. The patient was extubated without any complications.


CONCLUSIONS
Anesthesia management of similar cases should be focused around bleeding and hemodynamic destabilization and is harder in emergency surgery due to narrow time limits. Drug and liquids titration and use of drugs with minimum hemodynamic effects are advised, as well as close cardiovascular monitoring.