Correspondence  |   November 2017
In Reply
Author Notes
  • University of Michigan Health System, University of Michigan, Ann Arbor, Michigan (M.R.M.). mathism@med.umich.edu
  • (Accepted for publication July 28, 2017.)
    (Accepted for publication July 28, 2017.)×
Article Information
Correspondence
Correspondence   |   November 2017
In Reply
Anesthesiology 11 2017, Vol.127, 903-904. doi:10.1097/ALN.0000000000001854
Anesthesiology 11 2017, Vol.127, 903-904. doi:10.1097/ALN.0000000000001854
We thank Drs. Barbara and Freundlich et al. for their thoughtful responses to our recent article.1  In their responses, they highlight critical points regarding the management of patients with left ventricular assist devices (LVADs) presenting for noncardiac surgery. These points include: (1) LVAD patients are at high risk for perioperative complications; (2) frequency of invasive arterial line monitoring continues to decrease, despite high rates of intraoperative monitoring gaps; (3) potential hemodynamic instability in the setting of inadequate blood pressure monitoring may lead to increased incidence of complications (including acute kidney injury); and, as such, (4) alternatives to automated noninvasive cuff measurements for blood pressure monitoring must be more aggressively pursued.
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