- OBJECTIVE: Percutaneous mi-tral valve repair with the MitraClip system is an alternative procedure for high-risk patients not suitable for conventional surgery. The Mi-traClip can be safely performed under gener-al anesthesia (GA) or deep sedation (DS) with spontaneous breathing using a combination of propofol and remifentanil. This study aimed to evaluate the benefits of target-controlled infu-sion (TCI) of remifentanil and administration of propofol during DS compared with manual ad-ministration of total intravenous anesthesia (TI -VA) medication during GA in patients undergo-ing MitraClip. We assessed the impact of these procedures in terms of remifentanil dose, he-modynamic profile, adverse events, and days of hospital stay after the process.PATIENTS AND METHODS: From March 2013 to June 2015 (mean age 73.5 +/- 9,54), pa-tients underwent transcatheter MitraClip repair, 27 received DS via TCI and 27 GA with TIVA.RESULTS: Acute procedural success was 100%. DS-TCI group, in addition to a significant reduction of remifentanil dose administrated (249 mu g vs. 2865, p < 0.01), resulted in a decrease in vasopressor drugs requirement for hemodynam-ic adjustments (29.6% vs. 63%, p = 0.03) during the procedure and a reduction of hypotension (p = 0.08). The duration of postoperative hospital-ization did not differ between the two groups (5.4 days vs. 5.8 days, p = 0.4).CONCLUSIONS: Administration of remifen-tanil by TCI for DS in spontaneously breathing patients offers stable anesthesia conditions, with a lower amount of drugs, higher hemody-namic stability, and decreased side effects.
De Vico, P., Cammalleri, V., Marchei, M., Macrini, M., Lecis, D., Idone, G., et al. (2022). Target-controlled infusion during MitraClip procedures in deep-sedation with spontaneous breathing. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES, 26(22), 8437-8443 [10.26355/eurrev_202211_30379].
Target-controlled infusion during MitraClip procedures in deep-sedation with spontaneous breathing
De Vico, P;Cammalleri, V;Di Luozzo, M;Ussia, G P;Dauri, M;Muscoli, S
2022-11-01
Abstract
- OBJECTIVE: Percutaneous mi-tral valve repair with the MitraClip system is an alternative procedure for high-risk patients not suitable for conventional surgery. The Mi-traClip can be safely performed under gener-al anesthesia (GA) or deep sedation (DS) with spontaneous breathing using a combination of propofol and remifentanil. This study aimed to evaluate the benefits of target-controlled infu-sion (TCI) of remifentanil and administration of propofol during DS compared with manual ad-ministration of total intravenous anesthesia (TI -VA) medication during GA in patients undergo-ing MitraClip. We assessed the impact of these procedures in terms of remifentanil dose, he-modynamic profile, adverse events, and days of hospital stay after the process.PATIENTS AND METHODS: From March 2013 to June 2015 (mean age 73.5 +/- 9,54), pa-tients underwent transcatheter MitraClip repair, 27 received DS via TCI and 27 GA with TIVA.RESULTS: Acute procedural success was 100%. DS-TCI group, in addition to a significant reduction of remifentanil dose administrated (249 mu g vs. 2865, p < 0.01), resulted in a decrease in vasopressor drugs requirement for hemodynam-ic adjustments (29.6% vs. 63%, p = 0.03) during the procedure and a reduction of hypotension (p = 0.08). The duration of postoperative hospital-ization did not differ between the two groups (5.4 days vs. 5.8 days, p = 0.4).CONCLUSIONS: Administration of remifen-tanil by TCI for DS in spontaneously breathing patients offers stable anesthesia conditions, with a lower amount of drugs, higher hemody-namic stability, and decreased side effects.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
