Correspondence  |   November 2017
Noninvasive Blood Pressure Determination in Left Ventricular Assist Device Patients
Author Notes
  • Mayo Clinic College of Medicine, Rochester, Minnesota (D.W.B.). barbara.david@mayo.edu
  • (Accepted for publication July 28, 2017.)
    (Accepted for publication July 28, 2017.)×
Article Information
Correspondence
Correspondence   |   November 2017
Noninvasive Blood Pressure Determination in Left Ventricular Assist Device Patients
Anesthesiology 11 2017, Vol.127, 902-903. doi:10.1097/ALN.0000000000001853
Anesthesiology 11 2017, Vol.127, 902-903. doi:10.1097/ALN.0000000000001853
We read with great interest the intriguing study by Mathis et al.1  involving 702 noncardiac procedures performed in patients with left ventricular assist devices (LVADs). We commend the authors for their work in this important area and share their passion and enthusiasm for caring for LVAD patients perioperatively.
Mathis et al. reported that arterial line blood pressure (BP) was utilized in 20% of cases, with the remaining relying on noninvasive BP monitoring modalities. Interestingly, they report that 55% of all anesthetics had a greater than 20-min gap intraoperatively without a documented BP reading. Even more alarming is that 48% of their anesthetics had BP monitoring for less than 20% of minutes intraoperatively, and 31 cases lacked any BP recordings entirely. Further, in cases where an arterial line was employed, they report a monitoring gap of greater than 20 min in 32% of anesthetics occurring primarily between induction of anesthesia and arterial line placement. It is not reported in the manuscript whether the placement of arterial access was necessitated by the inability to obtain noninvasive BP readings or whether it was anticipated based upon patient and/or surgical factors. Mathis et al. stated that when BP was not recorded, “measures approximating vital organ perfusion were documented, including patient responsiveness (e.g., patient following commands, patient alert, etc.) in 11 cases and/or serial documentation of stable LVAD parameters (i.e., flow, power, and pulsatility index) in 29 cases.”
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