Kitaura Atsuhiro, Sakamoto Hiroatsu, Tsukimoto Shota, Yuasa Haruyuki, Nakajima Yasufumi
Anesthesiology, Kindai University, Osaka, JPN.
Dental Anesthesiology, Kanagawa Dental University, Yokosuka, JPN.
Cureus. 2024 Jul 16;16(7):e64628. doi: 10.7759/cureus.64628. eCollection 2024 Jul.
The transcarotid approach was introduced in Japan in April 2024 as an alternative approach for transcatheter aortic valve replacement (TAVR). Because carotid artery blood flow is reduced on one side during the procedure, there is a risk of intraoperative brain stroke. Therefore, it is crucial to check for cerebral complications immediately after the procedure. We report a case involving an 87-year-old female who underwent transcarotid TAVR under general anesthesia with remimazolam and remifentanil. The operation was completed in a short period. There was no evidence of hypotension during the induction of anesthesia, and intraoperative blood pressure control was easy. However, there was a decrease in local oxygen saturation for approximately nine minutes intraoperatively. Following the administration of flumazenil, the patient was quickly awakened, and neurological findings were confirmed to be normal. The patient was discharged without complications. Our findings suggest that remimazolam, an ultra-short-acting benzodiazepine, is feasible for the transcarotid TAVR procedure due to its minimal circulatory impact and ability to facilitate rapid and reliable arousal.
经颈动脉途径于2024年4月在日本被引入，作为经导管主动脉瓣置换术（TAVR）的一种替代途径。由于在手术过程中一侧颈动脉血流减少，存在术中脑卒的风险。因此，术后立即检查脑部并发症至关重要。我们报告一例87岁女性患者，在使用瑞马唑仑和瑞芬太尼全身麻醉下接受经颈动脉TAVR手术。手术在短时间内完成。麻醉诱导期间无低血压证据，术中血压控制容易。然而，术中局部氧饱和度下降约9分钟。给予氟马西尼后，患者迅速苏醒，神经学检查结果证实正常。患者无并发症出院。我们的研究结果表明，超短效苯二氮䓬类药物瑞马唑仑对经颈动脉TAVR手术是可行的，因为它对循环影响极小，且能够促进快速可靠的苏醒。
