Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medicine Rostock, Rostock, Germany
Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medicine Rostock, Rostock, Germany.
BMJ Open. 2021 Aug 4;11(8):e045330. doi: 10.1136/bmjopen-2020-045330.
Transfemoral transcatheter aortic valve implantation (TF-TAVI) is an established therapy for patients with symptomatic aortic stenosis, which requires periprocedural anaesthesia care. In 2015, the German Federal Joint Committee released a directive on minimally invasive heart valve interventions which defines institutional infrastructural requirements in German heart centres. But still generally accepted expert consensus recommendations or national or international guidelines regarding periprocedural anaesthesia management for TF-TAVI are lacking. This nationwide cross-sectional study had two major objectives: first to assess the concordance with existing national regulations regarding infrastructural requirements and second to evaluate the status quo of periprocedural anaesthesia management for patients undergoing TF-TAVI in German heart centres.
Multicentre cross-sectional online study to evaluate the periprocedural anaesthesia management.
In this nationwide cross-sectional study, electronic questionnaires were sent out to anaesthesia departments at TF-TAVI-performing centres in Germany in March 2019.
78 anaesthesia departments of German heart centres.
54 (69.2%) centres returned the questionnaire of which 94.4% stated to hold regular Heart Team meetings, 75.9% to have ready-to-use heart-lung machines available on-site, 77.8% to have cardiac surgeons and 66.7% to have perfusionists routinely attending throughout TF-TAVI procedures. Regarding periprocedural anaesthesia management, 41 (75.9%) of the participating centres reported to predominantly use 'monitored anaesthesia care' and 13 (24.1%) to favour general anaesthesia. 49 (90.7%) centres stated to use institutional standard operating procedures for anaesthesia. Five-lead ECG, central venous lines, capnometry and intraprocedural echocardiography were reported to be routine measures in 85.2%, 83.3%, 77.8% and 51.9% of the surveyed heart centres.
The concordance with national regulations, anaesthesia management and in-house standards for TF-TAVI vary broadly among German heart centres. According to the opinion of the authors, international expert consensus recommendations and/or guidelines would be helpful to standardise peri interventional anaesthesia care.
经股动脉主动脉瓣置换术（TF-TAVI）是一种治疗有症状的主动脉瓣狭窄患者的成熟疗法，需要围手术期麻醉护理。2015 年，德国联邦联合委员会发布了一项关于微创心脏瓣膜介入治疗的指令，规定了德国心脏中心的机构基础设施要求。但对于 TF-TAVI 的围手术期麻醉管理，仍然缺乏普遍接受的专家共识建议或国家或国际指南。这项全国性的横断面研究有两个主要目标：首先评估与现有国家法规在基础设施要求方面的一致性，其次评估德国心脏中心 TF-TAVI 患者围手术期麻醉管理的现状。
多中心横断面在线研究评估围手术期麻醉管理。
在这项全国性的横断面研究中，2019 年 3 月向德国 TF-TAVI 实施中心的麻醉科发送了电子问卷。
78 个德国心脏中心的麻醉科。
54 个（69.2%）中心返回了问卷，其中 94.4%表示定期举行心脏团队会议，75.9%有现场备用的心肺机，77.8%有心脏外科医生，66.7%有灌注师在整个 TF-TAVI 过程中常规参与。关于围手术期麻醉管理，41 个（75.9%）参与中心报告主要使用“监测麻醉护理”，13 个（24.1%）倾向于全身麻醉。49 个（90.7%）中心表示使用机构标准操作程序进行麻醉。5 导联心电图、中心静脉导管、呼气末二氧化碳监测和术中超声心动图在 85.2%、83.3%、77.8%和 51.9%的调查中心被报告为常规措施。
德国心脏中心在围手术期麻醉管理和机构内标准方面与国家法规的一致性差异很大。根据作者的观点，国际专家共识建议和/或指南将有助于规范围手术期麻醉护理。
