Wen-Bin Teng

Background: Left ventricular assist device (LVAD) implantation is a common intervention for patients with end-stage heart failure. However, comorbid chronic obstructive pulmonary disease (COPD) poses significant challenges in perioperative management. In such cases, ultrafast track anesthesia (UFTA) has been proposed to minimize cardiopulmonary disturbances and promote rapid recovery. Case: This report describes the case of a 53-year-old man diagnosed with dilated cardiomyopathy and COPD. Despite extensive medical treatment, the patient's condition did not improve, and his activities were strictly limited (New York Heart Association Class IV). Echocardiography revealed an enlarged heart with an ejection fraction of 24%. The patient was scheduled to undergo LVAD implantation via minimally invasive surgery. An UFTA protocol based on propofol and remifentanil was consequently designed and implemented. Postoperatively, the patient regained consciousness and exhibited stable respiratory function and hemodynamic parameters. On-table extubation was performed, and the patient was transferred to the intensive care unit. However, he received a butorphanol infusion after surgery and had to be re-intubated 23 h later. Conclusions: This case reveals that if a multidisciplinary team effort and tailored treatment protocols had not been executed, reintubation may not have been avoided, even though the patient had been extubated in the operating room shortly after surgery.