Analgosedation during transcatheter aortic valve implantation: Review and protocol at University Hospital Centre Split

    Authors

    Keywords

    analgosedation, transcatheter aortic valve implantation, propofol

    DOI

    https://doi.org/10.15836/ccar2021.293

    Full Text

    Background and aims: Periprocedural analgosedation during transcatheter aortic valve replacement (TAVR) has evolved significantly over the past decade. First procedures were done in general anaesthesia under the supervision of an anesthesiologist, while recent trends suggest periprocedural analgosedation performed by interventional cardiologists/TAVR operators ( 1 ). This method often includes different medications and protocols, depending on the site-specific preferences. Here we present a review of propofol effects along with the protocol utilized at the Catheterization Laboratory (Cath Lab) at the University Hospital Centre Split. Review and protocol presentation: Our primary used anaesthetic medication is propofol due to its beneficial pharmacologic properties including short action and titratable effects leading to effective sedation with amnesia, well-being and anti-emesis ( 2 ). In addition, it shows a good correlation with bispectral index (BIS) allowing for easier titration during longer procedures. However, due to its insufficient analgesia, we utilize high dose-volumes of local anaesthetic and optionally a systemic bolus-doses of fentanyl in selected individuals ( Figure 1 ). To this date, this protocol provided a safe, effective and reproducible periprocedural analgosedation during TAVR. Importantly, this protocol was successfully performed by the Cath Lab Team, without the need for additional healthcare resources or staff allocation ( 3 ). To avoid large radiation to the staff, we have also adjusted the equipment (use of long intravenous lines; rotation of X-ray tube; monitor orientation) and modified the staff position ( Figure 2 ). Illustrative overview of propofol plasma concentrations and bispecter index in relation to procedural phases (Split protocol). Schematic layout of the equipment/staff in the Cath Lab with regard to analgosedation. Conclusions : In conclusion, there are different regimens for periprocedural analgosedation. Periprocedural analgosedation with propofol in the bolus-continuous infusion scheme proved to be safe, effective and reproducible during TAVR. Interventional cardiologists and specialized Cath Lab team are trained to provide all aspects of management and care to these patients.

    Cardiologia Croatica
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    Analgosedation during transcatheter aortic valve implantation: Review and protocol at University Hospital Centre Split

    Extended Abstract
    Issue9-10
    Published
    Pages293-294
    PDF via DOIhttps://doi.org/10.15836/ccar2021.293
    analgosedation
    transcatheter aortic valve implantation
    propofol

    Authors

    Andrija Matetić*ORCIDUniversity Hospital Centre Split, Split, Croatia
    Marija RomićORCIDUniversity Hospital Centre Split, Split, Croatia
    Nikola CrnčevićORCIDUniversity Hospital Centre Split, Split, Croatia
    Ivica KristićORCIDUniversity Hospital Centre Split, Split, Croatia
    Vjekoslav TomulićORCIDUniversity Hospital Centre Rijeka, Rijeka, Croatia
    Frane RunjićORCIDUniversity Hospital Centre Split, Split, Croatia

    Full Text

    Background and aims: Periprocedural analgosedation during transcatheter aortic valve replacement (TAVR) has evolved significantly over the past decade. First procedures were done in general anaesthesia under the supervision of an anesthesiologist, while recent trends suggest periprocedural analgosedation performed by interventional cardiologists/TAVR operators ( 1 ). This method often includes different medications and protocols, depending on the site-specific preferences. Here we present a review of propofol effects along with the protocol utilized at the Catheterization Laboratory (Cath Lab) at the University Hospital Centre Split. Review and protocol presentation: Our primary used anaesthetic medication is propofol due to its beneficial pharmacologic properties including short action and titratable effects leading to effective sedation with amnesia, well-being and anti-emesis ( 2 ). In addition, it shows a good correlation with bispectral index (BIS) allowing for easier titration during longer procedures. However, due to its insufficient analgesia, we utilize high dose-volumes of local anaesthetic and optionally a systemic bolus-doses of fentanyl in selected individuals ( Figure 1 ). To this date, this protocol provided a safe, effective and reproducible periprocedural analgosedation during TAVR. Importantly, this protocol was successfully performed by the Cath Lab Team, without the need for additional healthcare resources or staff allocation ( 3 ). To avoid large radiation to the staff, we have also adjusted the equipment (use of long intravenous lines; rotation of X-ray tube; monitor orientation) and modified the staff position ( Figure 2 ). Illustrative overview of propofol plasma concentrations and bispecter index in relation to procedural phases (Split protocol). Schematic layout of the equipment/staff in the Cath Lab with regard to analgosedation. Conclusions : In conclusion, there are different regimens for periprocedural analgosedation. Periprocedural analgosedation with propofol in the bolus-continuous infusion scheme proved to be safe, effective and reproducible during TAVR. Interventional cardiologists and specialized Cath Lab team are trained to provide all aspects of management and care to these patients.