eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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4/2020
vol. 17
 
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abstract:
Original paper

General anaesthesia or sedation for percutaneous aortic valve implantation? The questionnaire results and authors’ experience

Ewa M. Kucewicz-Czech
1
,
Leszek Machej
1
,
Kazimierz Kiermasz
1
,
Andrzej Węglarzy
1
,
Maria Damps
2
,
Damian Hudziak
3
,
Radosław Gocol
3
,
Andrzej Ochała
4
,
Radosław Parma
4

  1. Department of Cardiac Anaesthesia and Intensicve Care Leszek Giec Upper-Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
  2. Department of Anaesthesiology and Intensive Care, Upper Silesian Child Health Centre, Katowice, Poland
  3. Department of Cardiac Surgery, Leszek Giec Upper-Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
  4. Third Department of Cardiology, Leszek Giec Upper-Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
Kardiochir Torakochir Pol 2020; 17 (4): 198-202
DOI: https://doi.org/10.5114/kitp.2020.102398
Online publish date: 2021/01/15
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Introduction
Over the last two decades transcatheter aortic valve replacement (TAVR) has been approved for clinical use. The anaesthetic choice for this procedure is evolving. General anaesthesia was the predominant anaesthetic technique. Growing experience and advances in technology and economic considerations have led to an increasing interest in performing TAVR under monitored sedation. Aim: The assessment of monitored sedation, called cooperative sedation, involves pharmacologically mediated suppression of consciousness and preservation of verbal contact in response to stimulation as a safe method of anaesthesia for TAVR.

Material and methods
Sixty out of 63 TAVR patients with femoral access received monitored sedation. Dexmedetomidine was administered in most of such cases (46 patients). A questionnaire was also carried out by staff involved in performing TAVR procedures, with more than 5 years of experience in it, concerning the method of anaesthesia and perioperative care.

Results
Conversion to general anaesthesia was required in 10% of patients (6 cases), only one as a patient-related complication (hypercarbia). The questionnaire carried out showed that anaesthesia and postoperative care after TAVR are underestimated.

Conclusions
The preliminary results regarding anaesthetic management in TAVR procedures demonstrate that monitored sedation is safe, provided that contraindications are observed.

keywords:

transcatheter aortic valve replacement, anaesthesia, conversion
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