Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, United States.
Department of Medical Education, West Virginia University, United States.
Ann Card Anaesth. 2023 Jan-Mar;26(1):29-35. doi: 10.4103/aca.aca_311_20.
General anesthesia has traditionally been used in transcatheter aortic valve replacement; however, there has been increasing interest and momentum in alternative anesthetic techniques.
To perform a descriptive study of anesthetic management options in transcatheter aortic valve replacements in the United States, comparing trends in use of monitored anesthesia care versus general anesthesia.
Data evaluated from the American Society of Anesthesiologists' (ASA) Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry.
Multivariable logistic regression was used to identify predictors associated with use of monitored anesthesia care compared to general anesthesia.
The use of monitored anesthesia care has increased from 1.8% of cases in 2013 to 25.2% in 2017 (p = 0.0001). Patients were more likely ages 80+ (66% vs. 61%; p = 0.0001), male (54% vs. 52%; p = 0.0001), ASA physical status > III (86% vs. 80%; p = 0.0001), cared for in the Northeast (38% vs. 22%; p = 0.0001), and residents in zip codes with higher median income ($63,382 vs. $55,311; p = 0.0001). Multivariable analysis revealed each one-year increase in age, every 50 procedures performed annually at a practice, and being male were associated with 3% (p = 0.0001), 33% (p = 0.012), and 16% (p = 0.026) increased odds of monitored anesthesia care, respectively. Centers in the Northeast were more likely to use monitored anesthesia care (all p < 0.005). Patients who underwent approaches other than percutaneous femoral arterial were less likely to receive monitored anesthesia care (adjusted odds ratios all < 0.51; all p = 0.0001).
Anesthetic type for transcatheter aortic valve replacements in the United States varies with age, sex, geography, volume of cases performed at a center, and procedural approach.
传统上，经导管主动脉瓣置换术采用全身麻醉；然而，替代麻醉技术的兴趣和动力日益增加。
对美国经导管主动脉瓣置换术的麻醉管理选择进行描述性研究，比较监测麻醉护理与全身麻醉的使用趋势。
从美国麻醉医师协会（ASA）麻醉质量研究所的国家麻醉临床结果登记处评估数据。
多变量逻辑回归用于确定与使用监测麻醉护理相比与全身麻醉相关的预测因素。
监测麻醉护理的使用从 2013 年的 1.8%增加到 2017 年的 25.2%（p = 0.0001）。患者年龄更大（66% vs. 61%；p = 0.0001）、男性（54% vs. 52%；p = 0.0001）、ASA 身体状况> III（86% vs. 80%；p = 0.0001）、在东北地区护理（38% vs. 22%；p = 0.0001），以及邮政编码中位数收入较高的居民（$63,382 与 $55,311；p = 0.0001）。多变量分析显示，年龄每增加一岁，每年在实践中进行的每 50 次操作，以及男性，与监测麻醉护理的几率分别增加 3%（p = 0.0001）、33%（p = 0.012）和 16%（p = 0.026）。东北地区的中心更有可能使用监测麻醉护理（所有 p < 0.005）。采用非经皮股动脉入路的患者接受监测麻醉护理的可能性较低（调整后的比值比均<0.51；所有 p = 0.0001）。
美国经导管主动脉瓣置换术的麻醉类型因年龄、性别、地理位置、中心手术量和手术入路而异。
