Full Text:   <2278>

CLC number: R614

On-line Access: 2017-04-05

Received: 2016-11-28

Revision Accepted: 2017-01-19

Crosschecked: 2017-03-27

Cited: 0

Clicked: 4338

Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Wei He

http://orcid.org/0000-0002-5466-7877

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Journal of Zhejiang University SCIENCE B 2017 Vol.18 No.4 P.353-359

http://doi.org/10.1631/jzus.B1600522


Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study


Author(s):  Wei He, Rong-rong Huang, Qing-yu Shi, Xian-bao Liu, Jian-an Wang, Min Yan

Affiliation(s):  Department of Anesthesia, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; more

Corresponding email(s):   yanm@z2hospital.com

Key Words:  Transcatheter aortic valve implantation, Sedation, Bispectral index


Wei He, Rong-rong Huang, Qing-yu Shi, Xian-bao Liu, Jian-an Wang, Min Yan. Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study[J]. Journal of Zhejiang University Science B, 2017, 18(4): 353-359.

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%T Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study
%A Wei He
%A Rong-rong Huang
%A Qing-yu Shi
%A Xian-bao Liu
%A Jian-an Wang
%A Min Yan
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T1 - Bispectral index-guided sedation in transfemoral transcatheter aortic valve implantation: a retrospective control study
A1 - Wei He
A1 - Rong-rong Huang
A1 - Qing-yu Shi
A1 - Xian-bao Liu
A1 - Jian-an Wang
A1 - Min Yan
J0 - Journal of Zhejiang University Science B
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DOI - 10.1631/jzus.B1600522


Abstract: 
Objective: transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for elderly patients with severe aortic valve stenosis who were refused surgical aortic valve replacement because of the high perioperative risk. Traditionally, this procedure has been done under general anesthesia, but more recently local anesthesia and sedation have become popular. This research assessed the effectiveness of transfemoral TAVI under bispectral index (BIS)-guided sedation. Methods: In this single-center retrospective control analysis, clinical data, including demographic characteristics, echocardiography, periprocedural data, and main complications, were collected and assessed in 113 patients undergoing TAVI through the femoral artery under general anesthesia (GA group, n=36) and under BIS-guided sedation (SED group, n=77). Results: The demographic characteristics and echocardiographic parameters between the two groups were similar (P>0.05). Two (2.6%) of patients were moved from BIS-guided sedation to general anesthesia for surgical reasons. Procedures were significantly shorter in the SED group than in the GA group ((127.10±44.43) min vs. (165.90±71.62) min, P=0.004). Patients in the SED group lost less blood and received significantly fewer red blood cells and catecholamines than those in the GA group (5.19% vs. 22.22%, P=0.017 and 67.53% vs. 97.22%, P<0.001). The length of hospital stay was significantly shorter and there were fewer pulmonary complications in the SED group than in the GA group. Thirty-day mortality was similar between the two groups. Conclusions: BIS-guided sedation is a feasible and safe approach for transfemoral TAVI. The anesthesiologist should choose the best anesthetic method according to the team’s experience.

脑电双频谱指数导向的镇静在股动脉入路经导管主动脉瓣植入术中的应用

目的:探讨脑电双频谱指数(BIS)导向的镇静在股动脉入路经导管主动脉瓣植入术(TAVI)中的可行性和有效性。
创新点:由于TAVI患者高龄、心功能差、合并症多,加上导管室布局不利于麻醉操作,实施镇静难度很大。我们利用目前常用的镇静监测手段BIS来实施导向镇静,有效地实现了深度可控的镇静,减少了并发症。
方法:回顾了本中心所有经股动脉入路的113名TAVI患者(图1)。将患者分为两组,其中36名患者进行了全身麻醉,77名患者施行了BIS导向的镇静。两组患者的术前一般情况的差别不显著 (表1)。术中资料显示,BIS导向的镇静组较全身麻醉组手术时间更短、失血更少、输血制品和血管活性药使用更少(表2)。术后的资料显示,两组的30天死亡率差异不显著,而BIS导向的镇静组有更短的住院时间和更少的肺部并发症(表3)。
结论:BIS导向的镇静在股动脉入路TAVI是安全可行的。各个临床中心可根据自身经验选择最合适的麻醉方法。

关键词:经导管主动脉瓣植入术;镇静;脑电双频谱指数

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference

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