title: Perioperative management of patients with left ventricular assist devices undergoing noncardiac procedures: a survey of current practices.
abstract: OBJECTIVE
  To describe perioperative management of patients with left ventricular assist devices (LVAD) in noncardiac procedures.
  
  
  METHODS
  Survey of (1) respondent demographic characteristics, (2) anesthetic practices for LVAD patients having endoscopies, and (3) low-risk surgeries requiring general anesthesia.
  
  
  METHODS
  Internet-based.
  
  
  METHODS
  Society of Cardiovascular Anesthesiologists membership.
  
  
  METHODS
  None.
  
  
  RESULTS
  Inpatient endoscopic procedures were done mainly in the endoscopy suite (71.7%) by a solo practitioner or 1:1 staffing ratio 59% of the time. LVAD-specific support personnel were present in more than 80% of all procedures. Both endoscopy and surgical patients used post-anesthesia recovery units and intensive care units for recovery; however, compared with endoscopy patients, surgical patients recovered in the ICU more frequently (45.5% v 29.1%, p<0.001). In addition, 18% of endoscopy patients recovered on site. Regarding patient monitoring, more than 90% of responders used electrocardiogram, pulse oximetry, end-tidal CO2, and blood pressure monitors on LVAD patients. Responders reported using arterial catheters to monitor blood pressure in 49% of endoscopy cases and 71% of surgical patients. The reported use of invasive monitors by individual clinicians was related inversely to institutional LVAD volume (p = 0.04 and p = 0.01 in endoscopy and surgical procedures, respectively).
  
  
  CONCLUSIONS
  This survey found heterogeneity in hospital resource utilization for noncardiac LVAD procedures. There was a decrease in the use of invasive monitors with increased institutional LVAD volume in both endoscopy and surgical procedures.
authors.affiliation: Department of Anesthesiology, Tufts Medical Center, Boston, MA.
authors.forename: Richard
authors.initials: R
authors.lastname: Sheu
authors.affiliation: Department of Anesthesiology, Tufts Medical Center, Boston, MA.
authors.forename: Brijen
authors.initials: B
authors.lastname: Joshi
authors.affiliation: Department of Anesthesiology, Penn State Hershey Medical Center, Hershey, PA.
authors.forename: Kane
authors.initials: K
authors.lastname: High
authors.affiliation: Department of Cardiac Surgery, Tufts Medical Center, Boston, MA.
authors.forename: Duc
authors.initials: D
authors.lastname: Thinh Pham
authors.affiliation: Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA.
authors.forename: Renata
authors.initials: R
authors.lastname: Ferreira
authors.affiliation: Department of Anesthesiology, Tufts Medical Center, Boston, MA. Electronic address: fcobey@gmail.com.
authors.forename: Frederick
authors.initials: F
authors.lastname: Cobey
mesh_terms: D000758:Anesthesia / Q000379:methods* / Q000592:standards; D000776:Anesthesiology / Q000379:methods* / Q000592:standards; D003625:Data Collection / Q000379:methods; D019468:Disease Management; D006353:Heart-Assist Devices / Q000592:standards; D006801:Humans; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D010820:Physicians / Q000592:standards; D012955:Societies, Medical / Q000592:standards
keywords: LVAD; anesthesia; endoscopy; left ventricular assist device; monitors; noncardiac surgery; survey