TITLE:
Ultrasound-Guided Axillary Block in an Anticoagulated Patient after Heartmate II Implantation
AUTHORS:
Giuseppe Trunfio, Boris Yaguda, Paul C. Saunders, Dennis E. Feierman
KEYWORDS:
Ultrasound-Guided Block, Anticoagulation LVAD
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.4 No.7,
July
21,
2014
ABSTRACT:
Objective: This case exemplifies the understanding of the physiological
changes associate with 1) Left Ventricular Assist Devices, 2) monitoring
challenges associated with Left Ventricular Assist Devices and 3) the
usefulness of peripheral nerve blocks in this subset of patients. Case report: A
73-year-old man was scheduled for left wrist arthroscopy and debridement to
treat a very painful septic joint. He had undergone Heartmate II Left
Ventricular Assist Device implantation uneventfully for Destination Therapy 4
months prior. The patient required maintenance of therapeutic anticoagulation. We
elected for an ultrasound-guided axillary block, which limits the risks of vascular
injury in presence of high INR. The axillary nerve block enabled us to overcome
potential anesthetic problems in a patient with a continuous flow LVAD. Conclusion:
The physiologic principles of Left Ventricular Assist Device function should be
understood before the initiation of anesthesia. Regional Anesthesiologists can
offer a very significant contribution to the safe care of patients with heart
failure requiring a continuous flow Left Ventricular Assist Device.