By Today, we had a guest speaker Christian Spies from Queen’s Hospital in Hawaii who spoke on his experience with his TAVR team and conscious sedation vs. general anesthesia for these patients. More specifically, we are speaking of the transfemoral route.
Keypoints:
- Patient selection is key (consider for COPD; bad for OSA)
- Short surgical time for monitored anesthesia care (MAC)
- Decrease invasive monitoring (no PA catheter,+/-CVP)
- No difference in hospital LOS or 1 year mortality rate
- Move from TEE to TTE if MAC
- Be prepared to convert MAC to GA (can be difficult in already tenuous patient in a crowded space under the drapes)
- MAC agents: dexmetetomidine, propofol, ofirimev
- Decrease pressor use
- Develop an algorithm for MAC vs. GA and patient selection
For my own lit search:
- Anaesthesia Nov 2011: Sedation vs general anaesthesia for the ‘high-risk’ patient – what can TAVI teach us?
- JACC May 2012: The Minimalist Approach for Transcatheter Aortic Valve Replacement in High-Risk Patients
- Cardiac Interventions Today May 2012: Rouen Experience Supports Safety of TAVR Using Local Anesthesia
- MedPage Today July 2012: TAVI: No Need for Patients to ‘Go Under’
- Amer J Card Jan 2013: Effect of Local Anesthetic Management With Conscious Sedation in Patients Undergoing Transcatheter Aortic Valve Implantation
- SCA 2013: PBL — Anesthesia for TAVR
- Indian Heart J March 2014: Transcatheter aortic valve implantation under conscious sedation – the first Indian experience
- TCTMD Mar 2015:As TAVR Evolves, Local Anesthesia Could Be an Option for Lower-Risk Patients
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