Objectives
The objective of the study was to compare the overall feasibility, respiratory and
hemodynamic stability, as well as process times of a dexmedetomidine-based sedative
regimen compared with general anesthesia among patients undergoing MitraClip procedures.
Design
A retrospective cohort study.
Setting
A single tertiary care university center.
Participants
The study included 79 patients.
Interventions
Dexmedetomidine sedation versus general anesthesia.
Measurements and Main Results
Seventy-nine MitraClip procedures in dexmedetomidine/remifentanil conscious sedation
(DCS, n = 26) or general anesthesia (GA, n = 53), performed between 2018 and 2020
at Charité – Universitätsmedizin Berlin, were analyzed retrospectively. Patients’
median age was 81 years in both groups without differences in preinterventional EuroScore
I (DCS 6 [5; 8], GA 7 [6; 8]) or systolic function (left ventricular ejection fraction:
DCS 50% [32; 60] v. GA 50% [36; 60]; tricuspid annular plane systolic excursion: DCS 19 mm [16; 22]
v GA 19 mm [15; 22]).
During MitraClip procedures, respiratory parameters revealed no differences between
groups, whereas patients under DCS showed higher mean arterial pressures (DCS 64 mmHg
[59; 74] v GA 58 mmHg [53; 66]) and needed less norepinephrine (DCS 0.0µg/kg/min [0.0; 0.2]
v GA 0.08 µg/kg/min [0.05; 0.15]). Emergence from both anesthesia regimens to readiness
for intensive care unit transfer was faster in DCS (8 min [4; 18] v GA 16 min [11; 23]); however, total process time was comparable between groups (DCS
128 min [104; 155] v GA 142 min [117; 190]). Two patients required a switch from DCS to GA due to oral
bleeding or prolonged procedure time. Both were excluded from the analysis. There
was no switch to open surgery and no differences in postoperative complications between
DCS and GA.
Conclusion
Dexmedetomidine/remifentanil sedation appears to be feasible and a safe option for
MitraClip procedures, and provides better hemodynamic stability with faster emergence
times compared with general anesthesia.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Anesthesia management for MitraClip device implantation.Ann Card Anaesth. 2014; 17: 17-22
- Comparison of deep sedation with general anesthesia in patients undergoing percutaneous mitral valve repair.J Am Heart Assoc. 2017; 6e007485
- Deep sedation vs. general anesthesia in 232 patients undergoing percutaneous mitral valve repair using the MitraClip system.Catheter Cardiovasc Interv. 2017; 90: 1212-1219
- Transcatheter mitral valve repair with the MitraClip can be performed without general anesthesia and without conscious sedation.Clin Res Cardiol. 2016; 105: 297-306
- Deep sedation versus general anesthesia in percutaneous edge-to-edge mitral valve reconstruction using the MitraClip system.Clin Res Cardiol. 2016; 105: 535-543
- Safety and efficacy of deep sedation as compared to general anaesthesia in percutaneous mitral valve repair using the MitraClip system.Catheter Cardiovasc Interv. 2014; 84: E38-E42
- Percutaneous mitral valve repair with the MitraClip system under deep sedation and local anaesthesia.EuroIntervention. 2012; 8: 587-590
- Comparison of sedation between dexmedetomidine and propofol during transesophageal echocardiography: A randomized controlled trial.Ann Card Anaesth. 2019; 22: 285-290
- Dexmedetomidine versus midazolam in procedural sedation. A systematic review of efficacy and safety.PLoS One. 2017; 12e0169525
- Propofol-based versus dexmedetomidine-based sedation in cardiac surgery patients.J Cardiothorac Vasc Anesth. 2013; 27: 1289-1294
- Drugs. 2011; 71: 1481-1501
- Efficacy and safety of sedation with dexmedetomidine in critical care patients: A meta-analysis of randomized controlled trials.Anaesth Crit Care Pain Med. 2016; 35: 7-15
- Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically ill patients: A meta-analysis of randomized controlled trials.J Cardiothorac Vasc Anesth. 2014; 28: 1459-1466
- The effect of dexmedetomidine on outcomes of cardiac surgery in elderly patients.J Cardiothorac Vasc Anesth. 2016; 30: 1502-1508
- Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO).Kidney Int. 2005; 67: 2089-2100
- Surgery and portal hypertension.Major Probl Clin Surg. 1964; 1: 1-85
- 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2021; 43: 561-632
- Updated recommendation: Personnel, spatial conditıons, equipment and organizational requirements as well as requirements for the provision of anesthesia services in cardiac surgery and interventional cardiology procedures.Anästh Intensivmed. 2016; : 92-95
- Position on monitored anesthesia care.https://www.asahq.org/standards-and-guidelines/position-on-monitored-anesthesia-care. [Last accessed 09.09.2022]. American Society of Anesthesiologists (ASA), 2018: 1-2
- The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients.Am J Respir Crit Care Med. 2002; 166: 1338-1344
- Evaluation of effectiveness and safety of transcatheter mitral valve repair under moderate conscious sedation.J Invasive Cardiol. 2020; 3: 206-210
- Deep sedation versus general anaesthesia for transcatheter mitral valve repair: An individual patient data meta-analysis of observational studies.EuroIntervention. 2021; 16: 1359-1365
- Effects of propofol, dexmedetomidine, or ketofol on respiratory and hemodynamic profiles in cardiac patients undergoing transesophageal echocardiography: A prospective randomized study.J Cardiothorac Vasc Anesth. 2021; 35: 2743-2750
- Dexmedetomidine versus propofol at different sedation depths during drug-induced sleep endoscopy: A randomized trial.Laryngoscope. 2020; 130: 257-262
- Dexmedetomidine versus propofol during drug-induced sleep endoscopy and sedation: A systematic review.Sleep Breath. 2017; 21: 727-735
- Procedural sedation with dexmedetomidine during ablation of atrial fibrillation: A randomized controlled trial.Europace. 2014; 16: 994-999
- High body mass index is a risk factor for difficult deep sedation in percutaneous mitral valve repair.PLoS One. 2018; 13e0190590
- Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery.Anesthesiology. 2015; 123: 307-319
- Intraoperative dexmedetomidine attenuates norepinephrine levels in patients undergoing transsphenoidal surgery: A randomized, placebo-controlled trial.BMC Anesthesiol. 2020; 20: 100
- Organ-protective effects and the underlying mechanism of dexmedetomidine.Mediators Inflamm. 2020; 20206136105
- Can dexmedetomidine improve arterial oxygenation and intrapulmonary shunt during one-lung ventilation in adults undergoing thoracic surgery? A meta-analysis of randomized, placebo-controlled trials.Chin Med J (Engl). 2017; 130: 1707-1714
- Effect of dexmedetomidine on cardiac surgery-associated acute kidney injury: A meta-analysis with trial sequential analysis of randomized controlled trials.J Cardiothorac Vasc Anesth. 2020; 34: 603-613
- Effects of different doses of remifentanil on hemodynamic response to anesthesia induction in healthy elderly patients.Curr Med Res Opin. 2017; 33: 85-90
- Dexmedetomidine, delirium, and adverse outcomes: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database.Ann Thorac Surg. 2021; 112: 1886-1892
- Cerebral embolisation during transcatheter edge-to-edge repair of the mitral valve with the MitraClip system: A prospective, observational study.EuroIntervention. 2022; 18: e160-e168
Article info
Publication history
Published online: October 08, 2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
