Kucewicz-Czech Ewa M, Machej Leszek, Kiermasz Kazimierz, Węglarzy Andrzej, Damps Maria, Hudziak Damian, Gocoł Radosław, Ochała Andrzej, Parma Radosław
Department of Cardiac Anaesthesia and Intensive Care Leszek Giec Upper-Silesian Medical Centre, Medical University of Silesia, Katowice, Poland.
Department of Anaesthesiology and Intensive Care, Upper Silesian Child Health Centre, Katowice, Poland.
Kardiochir Torakochirurgia Pol. 2020 Dec;17(4):198-202. doi: 10.5114/kitp.2020.102398. Epub 2021 Jan 15.
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.
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.
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.
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.
The preliminary results regarding anaesthetic management in TAVR procedures demonstrate that monitored sedation is safe, provided that contraindications are observed.
在过去二十年中，经导管主动脉瓣置换术（TAVR）已获批用于临床。该手术的麻醉选择正在不断发展。全身麻醉曾是主要的麻醉技术。随着经验的积累、技术的进步以及经济因素的考量，人们对在监测镇静下进行TAVR的兴趣日益浓厚。
对被称为协同镇静的监测镇静进行评估，涉及通过药物介导抑制意识并在受到刺激时保持言语交流，作为TAVR的一种安全麻醉方法。
63例经股动脉途径的TAVR患者中有60例接受了监测镇静。大多数此类病例（46例患者）使用了右美托咪定。参与TAVR手术且有超过5年相关经验的工作人员还就麻醉方法和围手术期护理进行了问卷调查。
10%的患者（6例）需要转为全身麻醉，仅1例是与患者相关的并发症（高碳酸血症）。所进行的问卷调查显示，TAVR后的麻醉和术后护理被低估了。
TAVR手术麻醉管理的初步结果表明，只要遵循禁忌证，监测镇静是安全的。
