Objective
Comparison of remifentanil versus propofol for sedation during transcatheter aortic
valve replacement (TAVR) procedures to analyze the risk of sedation-related hypoxemia
and hypotension. Secondary outcomes included the rate of conversion to general anesthesia,
procedure length, rate of intensive care unit (ICU) admission, ICU and hospital lengths
of stay, and 30-day mortality.
Design
Retrospective cohort study.
Setting
A single tertiary teaching hospital.
Participants
Two hundred fifty-nine patients who had propofol or remifentanil sedation for TAVR
between March 2017 and March 2020.
Intervention
None.
Measurements and Main Results
There were 130 patients (50.2%) in the propofol cohort and 129 patients (49.8%) in
the remifentanil cohort. The primary outcomes were oxygen saturation nadir values
and vasopressor infusion use. Remifentanil was associated with a lower oxygen saturation
nadir, as compared to propofol (91.3% v . 95.4%, p < 0.001). Risk factors associated with hypoxemia (defined as <92%) were
body mass index (p = 0.0004), obstructive sleep apnea (p = 0.004), and remifentanil
maintenance (p < 0.001). Vasopressor infusion use was significantly higher with propofol
(64.9% v . 8.5%, p < 0.001). Propofol maintenance and angiotensin-converting enzyme inhibitor/angiotensin
II receptor-blocker use were the only variables identified as risk factors for vasopressor
use (p < 0.001 and p = 0.009).
Conclusions
For patients undergoing TAVR with conscious sedation, remifentanil was associated
with more hypoxemia while propofol was associated with a higher rate of vasopressor
use.
Key Words
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Article info
Publication history
Published online: May 03, 2021
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