Skip to main content Accessibility help
  • Print publication year: 2011
  • Online publication date: May 2011

Case 73 - Anestheticmanagement for subdural hematoma evacuation in a patient with a left ventricular assist device

from Section I - Neuroanesthesia


This chapter presents a case study of a 3-month-old male who had an uncomplicated term delivery presented for repair of craniosynostosis. Premedication was avoided and a peripheral intravenous catheter was started because of the young age, presence of mid-facial hypoplasia, and concern regarding potential problems with ventilation and intubation. Probably the most challenging part of the anesthetic management of craniosynostosis repair is the significant blood loss and frequent rate of blood product transfusion. Craniosynostosis repair presents a number of challenges to the anesthesiologist: (1) small size of the patients; (2) significant and often unavoidable blood loss; (3) need for intraoperative transfusion of blood products; and (4) associated anomalies including airway problems and obstructive sleep apnea. All of these potential complications call for careful preoperative and intraoperative planning, meticulous attention to intravascular volume status and hemodynamic stability as well as maintenance of normothermia.


1. A. E. Eckhauser, W. V. Melvin, K. W. Sharp. Management of general surgical problems in patients with left ventricular assist devices. Am Surg 2006; 72: 158–61.
2. A. Garatti, G. Bruschi, T. Colombo et al. Noncardiac surgical procedures in patient supported with long-term implantable left ventricular assist device. Am J Surg 2009; 197; 710–14.
3. E. A Rose, A. C. Gelijns, A. J. Moskowitz et al. Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med 2001; 345: 1435–43.
4. O. H. Frazier, C. Gemmato, T. J. Myers et al. Initial clinical experience with the HeartMate II axial-flow left ventricular assist device. Tex Heart Inst J 2007; 34: 275–81.
5. V. Kartha, W. Gomez, B. Wu et al. Laparoscopic cholecystectomy in a patient with an implantable left ventricular assist device. Br J Anaesth 2008; 100: 652–5.
6. R. John, F. Kamdar, K. Liao et al. Improved survival and decreasing incidence of adverse events with the HeartMate II left ventricular assist device as bridge-to-transplant therapy. Ann Thorac Surg 2008; 86: 1227–34.
7. A. C. Nicolosi, P. S. Pagel. Perioperative considerations in the patient with a left ventricular assist device. Anesthesiology 2003; 98: 565–70.
8. D. J. Goldstein, S. L. Mullis, E. S. Delphin et al. Noncardiac surgery in long-term implantable left ventricular assist-device recipients. Ann Surg 1995; 222: 203–7.
9. S. T. Webb, V. Patil, A. Vuylsteke. Anaesthesia for non-cardiac surgery in patient with Becker's muscular dystrophy supported with a left ventricular assist device. Eur J Anaesthesiol 2007; 24: 640–2.
10. N. C. Dang, Y. Naka. Perioperative pharmacotherapy in patients with left ventricular assist devices. Drugs Aging 2004; 21: 993–1012.