Comparison of Procedural Sedation With Propofol and Dexmedetomidine During Transcatheter Aortic Valve Replacement Using the Transfemoral Approach

Racman, Pia Vovk; Kšela, Juš; Racman, Mark; Žerjav, Urška; Šoštarič, Maja

doi:10.1053/j.jvca.2023.05.009

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…The hemodynamic effects of propofol during TAVR compared to other sedative drugs has been examined before. [ 19 20 21 22 23 24 ] The drug was generally safe specially when smaller dose is used. For example, propofol and dexmedetomidine were compared in two studies in TAVR patients, with no significant differences in intraoperative use of vasoactive drugs, in-hospital outcomes, and 30-day outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…For example, propofol and dexmedetomidine were compared in two studies in TAVR patients, with no significant differences in intraoperative use of vasoactive drugs, in-hospital outcomes, and 30-day outcomes. [ 19 21 ] On the contrary, propofol in a relatively higher dose and with a concomitant infusion of remifentanil or fentanyl boluses was associated with higher catecholamine use compared with dexmedetomidine in TAVR patients. [ 22 ] Similarly, propofol infusion in quite high dose required more vasopressors than remifentanil infusion in TAVR patients.…”

Section: Discussionmentioning

confidence: 99%

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The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement

Abuzaid,

AbdelAal,

Galal

2024

Saudi Journal of Anaesthesia

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Background: There is an increasing number of patients undergoing transfemoral aortic valve replacement (TAVR) with sedation. There is limited data assessing the efficacy and safety of the different types of sedative drugs. The objective was to compare two sedation techniques with regard to the need for vasoactive support, respiratory support, rate of conversion to general anesthesia (GA), common perioperative morbidities, intensive care unit (ICU) stay, and in-hospital mortality. Methods: A retrospective chart review study conducted among patients who underwent TAVR at a specialized cardiac center between January 2016 and December 2019. Data collection included patient diagnosis, preoperative comorbidities, intraoperative outcomes, and postoperative outcomes. Results: A total of 289 patients received local anesthesia; 210 received propofol infusion and 79 received a mixed propofol-ketamine infusion (Ketofol). The average age was 75.5 ± 8.9 years and 58.1% of the patients were females. Comparing propofol and ketofol groups, 31.2% and 34.2% of the patients required drug support, 7.6% and 6.3% required conversion to GA, 46.7% and 59.5% required respiratory support, respectively. These intraoperative outcomes were not significantly different between groups, P = 0.540, P = 0.707, and P = 0.105, respectively. In-hospital 30-day mortality in propofol and ketofol groups were 1.9% and 3.8%, respectively, P = 0.396. In both groups, the median post-procedure coronary care unit stay was 26 hours while post-procedure hospital stay was 3 days. Conclusions: There were no significant differences in perioperative or postoperative outcomes in TAVR patients receiving either propofol or ketofol. Propofol infusion, either alone or with ketamine, is reliable and safe, with minimal side effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement

Abuzaid,

AbdelAal,

Galal

2024

Saudi Journal of Anaesthesia

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“…Research findings indicate that the utilization of propofol as an anesthetic agent may result in a decreased occurrence of delayed neurocognitive recuperation in comparison to the use of volatile anesthetics ( 27 ). However, most previous studies have only utilized declines in Mini-Mental State Examination scores as a diagnostic measure for delayed neurocognitive recovery ( 28 ). The main objective of our investigation was to evaluate whether variations existed in the occurrence of postponed neurocognitive recuperation among individuals who received general anesthesia predominantly sustained with CIVIA and TIVA, particularly for laparoscopic procedures.…”

Section: Discussionmentioning

confidence: 99%

Comparison of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic surgery and the identification of predictive factors influencing the delayed recovery of neurocognitive function

Song,

Wu,

2024

Front. Med.

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BackgroundCompare the anesthesia effects of combined intravenous and inhalation anesthesia (CIVIA) and total intravenous anesthesia (TIVA) in laparoscopic surgery. Furthermore, our objective is to examine the elements that contribute to the delay in postoperative recovery of neurocognitive function and anticipate the manifestation of delayed recovery by analyzing serum cytokines.MethodsThe CIVIA group and the TIVA group both consisted of 130 patients who were scheduled to have elective major abdominal surgery through laparoscopy. The criteria taken into account by the observational and record-keeping study were the patients’ ages, sexes, body masses, heights, and the presence or absence of any preexisting problems. Both groups also had their anesthetic depth, duration, and per-unit-of-time muscle relaxant and analgesic dosages recorded. Finally, the length of each patient’s stay in the hospital as well as their overall length of stay were tracked. By using the Mini-Mental State Examination (MMSE) to measure cognitive function, we assessed the mental states of the subjects. Additionally, we wanted to identify any biomarkers that could be linked to postoperative cognitive decline or delays in neurocognitive recovery.ResultsA total of 51 participants from the CIVIA group and 53 participants from the TIVA group satisfactorily completed the necessary neuropsychological exam for identifying delayed neurocognitive recovery at the study’s completion. In the initial data of the two groups, no significant discrepancies were found (p > 0.05). The CIVIA group exhibited noteworthy reductions in the quantity of administered analgesics and muscle relaxants per unit of time in comparison to the TIVA group (p < 0.05). In addition to this, the duration from the sevoflurane tank being closed to the extubation period demonstrated a significant reduction in the CIVIA group compared to the TIVA group (p < 0.05). Moreover, no statistically notable distinction was observed in terms of postoperative hospitalization duration and overall hospitalization duration among both groups (p > 0.05). According to the study, both the CIVIA group and the TIVA group had a total of 7 (13.72%) and 17 (32.07%) individuals, respectively, who met the criteria for neurocognitive delayed recovery (Odds Ratio: 0.336; 95% CI: 0.134–0.864; p = 0.026). According to the research findings, it is indicated that there is a possibility for an increased presence of IL-6 in the bloodstream within 60 min following the incision made on the skin. This occurrence subsequently leads to the prolonged restoration of neurocognitive capabilities.ConclusionThe CIVIA technique outperforms the TIVA method in terms of overall assessment in the setting of laparoscopic surgery. It’s also important to remember that an increased blood IL-6 level during laparoscopy may operate as a separate risk factor for a delay in the restoration of neurocognitive function.

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Clinical insights on adverse effects of general anaesthetics and therapeutic gases

Bold,

Granger,

Hall

2024

Side Effects of Drugs Annual

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Comparison of Procedural Sedation With Propofol and Dexmedetomidine During Transcatheter Aortic Valve Replacement Using the Transfemoral Approach

Cited by 4 publications

References 31 publications

The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement

The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement

Comparison of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic surgery and the identification of predictive factors influencing the delayed recovery of neurocognitive function

Clinical insights on adverse effects of general anaesthetics and therapeutic gases

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