Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
BMC Pulm Med. 2021 May 15;21(1):164. doi: 10.1186/s12890-021-01541-3.
In this retrospective observational study, we analyzed all patients with pulmonary arterial hypertension undergoing LenusPro® pump implantation between November 2013 and October 2019 at our center. Periprocedural safety was assessed by describing all complications that occurred within 28 days after surgery; complications that occurred later were described to assess long-term safety. Clinical outcomes were measured by comparison of clinical parameters and echocardiographic measurements of right ventricular function from baseline to 6-months-follow-up.
Fifty-four patients underwent LenusPro® pump implantation for intravenous treprostinil treatment during the investigation period. Periprocedural complications occurred in 5 patients; the only anesthesia-related complication (right heart failure with recovery after prolonged intensive care and death in the further course) occurred in the only patient who underwent general anesthesia. All other patients underwent local anesthesia with or without short-acting (analgo-) sedation. Eighteen long-term complications occurred in 15 patients, most notably pump pocket or catheter related problems. Transplant-free survival rates at 1, 2, and 3 years were 77 %, 56 %, and 48 %, respectively.
Subcutaneous pump implantation under local anesthesia and conscious analgosedation while avoiding intubation and mechanical ventilation is feasible in patients with advanced PAH. Controlled studies are needed to determine the safest anesthetic approach for this procedure.
BACKGROUND/OBJECTIVES: Intravenous treprostinil treatment via a fully implantable pump is a treatment option for patients with advanced pulmonary arterial hypertension. However, there is no consensus on the preferred anesthetic approach for the implantation procedure. Primary objective was to assess periprocedural safety with particular attention to feasibility of local anesthesia and conscious analgosedation instead of general anesthesia. Long-term safety and clinical outcomes were secondary endpoints.
本回顾性观察研究分析了 2013 年 11 月至 2019 年 10 月在我院接受 LenusPro®泵植入术的所有肺动脉高压患者。通过描述术后 28 天内发生的所有并发症评估围手术期安全性；描述较晚发生的并发症以评估长期安全性。通过比较基线至 6 个月随访时的临床参数和右心功能的超声心动图测量来评估临床结果。
在研究期间，54 例患者因静脉注射曲前列素而接受 LenusPro®泵植入术。5 例患者发生围手术期并发症；唯一的麻醉相关并发症（右心衰竭，经长时间重症监护和进一步治疗后恢复）发生在唯一接受全身麻醉的患者中。所有其他患者均接受局部麻醉，或局部麻醉联合或不联合短效（镇痛）镇静。15 例患者发生 18 例长期并发症，最常见的是泵袋或导管相关问题。1、2 和 3 年无移植生存率分别为 77%、56%和 48%。
在避免插管和机械通气的情况下，在局部麻醉和清醒镇静下进行皮下泵植入术对于晚期 PAH 患者是可行的。需要进行对照研究以确定该手术最安全的麻醉方法。
背景/目的：通过完全可植入泵静脉注射曲前列素是治疗晚期肺动脉高压患者的一种选择。然而，对于植入手术，尚无首选麻醉方法的共识。主要目标是评估围手术期安全性，特别关注局部麻醉和清醒镇静而非全身麻醉的可行性。长期安全性和临床结果是次要终点。
