Recommendations for anaesthetic management during LT-MCS implantation
| Recommendations | Class | Level | References |
| Monitoring | |||
| The introduction of an arterial line in advance of anaesthesia induction is recommended. | I | C | [214–216] |
| Use of a central venous line is recommended. | I | C | [214–216] |
| A pulmonary artery catheter should be considered. | IIa | C | [222–224] |
| Neuromonitoring with electroencephalography may be considered. | IIb | C | [225] |
| Neuromonitoring with near infrared spectroscopy should be considered, especially in off-pump implantation. | IIa | C | [243] |
| Periprocedural transoesophageal echocardiography | |||
| It is recommended that the following assessments be performed using periprocedural transoesophageal echocardiography: intracavitary thrombus identification, detection of patent foramen ovale and other intracardiac shunts, assessment of aortic regurgitation, right ventricle assessment, inflow cannula positioning and outflow cannula positioning. | I | C | [230] |
| Assessment of right ventricular failure | |||
| Transoesophageal echocardiography guidance for weaning from CPB/extracorporeal life support is recommended. | IIa | C | |
| iNO, milrinone and phosphodiesterase type 5 inhibitors to lower pulmonary vascular resistance should be considered. | IIa | B | [236, 244–246] |
| Recommendations | Class | Level | References |
| Monitoring | |||
| The introduction of an arterial line in advance of anaesthesia induction is recommended. | I | C | [214–216] |
| Use of a central venous line is recommended. | I | C | [214–216] |
| A pulmonary artery catheter should be considered. | IIa | C | [222–224] |
| Neuromonitoring with electroencephalography may be considered. | IIb | C | [225] |
| Neuromonitoring with near infrared spectroscopy should be considered, especially in off-pump implantation. | IIa | C | [243] |
| Periprocedural transoesophageal echocardiography | |||
| It is recommended that the following assessments be performed using periprocedural transoesophageal echocardiography: intracavitary thrombus identification, detection of patent foramen ovale and other intracardiac shunts, assessment of aortic regurgitation, right ventricle assessment, inflow cannula positioning and outflow cannula positioning. | I | C | [230] |
| Assessment of right ventricular failure | |||
| Transoesophageal echocardiography guidance for weaning from CPB/extracorporeal life support is recommended. | IIa | C | |
| iNO, milrinone and phosphodiesterase type 5 inhibitors to lower pulmonary vascular resistance should be considered. | IIa | B | [236, 244–246] |
CPB: cardiopulmonary bypass; iNO; inhaled nitric oxide; LT-MCS: long-term mechanical circulatory support.
Recommendations for anaesthetic management during LT-MCS implantation
| Recommendations | Class | Level | References |
| Monitoring | |||
| The introduction of an arterial line in advance of anaesthesia induction is recommended. | I | C | [214–216] |
| Use of a central venous line is recommended. | I | C | [214–216] |
| A pulmonary artery catheter should be considered. | IIa | C | [222–224] |
| Neuromonitoring with electroencephalography may be considered. | IIb | C | [225] |
| Neuromonitoring with near infrared spectroscopy should be considered, especially in off-pump implantation. | IIa | C | [243] |
| Periprocedural transoesophageal echocardiography | |||
| It is recommended that the following assessments be performed using periprocedural transoesophageal echocardiography: intracavitary thrombus identification, detection of patent foramen ovale and other intracardiac shunts, assessment of aortic regurgitation, right ventricle assessment, inflow cannula positioning and outflow cannula positioning. | I | C | [230] |
| Assessment of right ventricular failure | |||
| Transoesophageal echocardiography guidance for weaning from CPB/extracorporeal life support is recommended. | IIa | C | |
| iNO, milrinone and phosphodiesterase type 5 inhibitors to lower pulmonary vascular resistance should be considered. | IIa | B | [236, 244–246] |
| Recommendations | Class | Level | References |
| Monitoring | |||
| The introduction of an arterial line in advance of anaesthesia induction is recommended. | I | C | [214–216] |
| Use of a central venous line is recommended. | I | C | [214–216] |
| A pulmonary artery catheter should be considered. | IIa | C | [222–224] |
| Neuromonitoring with electroencephalography may be considered. | IIb | C | [225] |
| Neuromonitoring with near infrared spectroscopy should be considered, especially in off-pump implantation. | IIa | C | [243] |
| Periprocedural transoesophageal echocardiography | |||
| It is recommended that the following assessments be performed using periprocedural transoesophageal echocardiography: intracavitary thrombus identification, detection of patent foramen ovale and other intracardiac shunts, assessment of aortic regurgitation, right ventricle assessment, inflow cannula positioning and outflow cannula positioning. | I | C | [230] |
| Assessment of right ventricular failure | |||
| Transoesophageal echocardiography guidance for weaning from CPB/extracorporeal life support is recommended. | IIa | C | |
| iNO, milrinone and phosphodiesterase type 5 inhibitors to lower pulmonary vascular resistance should be considered. | IIa | B | [236, 244–246] |
CPB: cardiopulmonary bypass; iNO; inhaled nitric oxide; LT-MCS: long-term mechanical circulatory support.
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