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Dexmedetomidine Sedation Combined With Remifentanil in MitraClip Procedures is Feasible and Improves Hemodynamics

  • Christian Berger
    Correspondence
    Address correspondence to Christian Berger, MD, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Berlin, Germany, Hindenburgdamm 30, 12203 Berlin, Germany.
    Affiliations
    Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
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  • Ebtisam Said
    Affiliations
    Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
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  • Katharina Haller
    Affiliations
    Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
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  • Michael Nordine
    Affiliations
    Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
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  • Markus Reinthaler
    Affiliations
    Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität andHumboldt Universität zu Berlin, Department of Cardiology, Campus BenjaminFranklin, Berlin, Germany
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  • Ulf Landmesser
    Affiliations
    Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität andHumboldt Universität zu Berlin, Department of Cardiology, Campus BenjaminFranklin, Berlin, Germany
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  • Sascha Treskatsch
    Affiliations
    Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität zu Berlin, Department of Anesthesiology and Intensive CareMedicine, Charité Campus Benjamin Franklin, Berlin, Germany
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Published:October 08, 2022DOI:https://doi.org/10.1053/j.jvca.2022.10.001

      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

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