Abstract
Objective: comparison of general anesthesia (GA) and intravenous conscious sedation during left atrial appendage occlusion (LAAO).Materials and Methods. The study included 120 patients from LAAO Register at the National Medical Research Center of Cardiology, who were divided into GA (n = 100) and intravenous sedation (n = 20) groups. In-hospital outcomes were assessed, as well as outcomes and data of transesophageal echocardiography (TEE) at 45 days and 6 months.Results. 3 patients required intraoperative conversion of the anesthetic method to GA. The duration of the procedure, the time of fluoroscopy, the amount of contrast medium, and the technical success did not differ signifcantly between the two groups. The incidence of in-hospital complications in the GA group was 10%, and 15% in the intravenous sedation group (p = 0.453). There were no statistically signifcant differences between the groups in long-term outcomes and TEE data after 45 days and 6 months.Conclusion. Combined intravenous sedation with local anesthesia is an effective and fairly safe method of anesthesiological support for implantation of the occluder of the left atrial auricle. It can be used in patients with a high risk of GA, with predictable difculties of tracheal intubation, as well as if the patient wishes accordingly. The limitations of the use of intravenous sedation in combination with local anesthesia are anatomical variants of SFM that are difcult for occluder implantation, as well as the patient's low tolerance to ECG in consciousness.
Highlights
Согласно рекомендациям Европейского общества кардиологов и Американской ассоциации сердца, основным методом профилактики при неклапанной Фибрилляция предсердий (ФП) в настоящее время является прием новых оральных антикоагулянтов (НОАК) [3, 6]
Combined intravenous sedation with local anesthesia is an effective and fairly safe method of anesthesiological support for implantation of the occluder of the left atrial auricle. It can be used in patients with a high risk of general anesthesia (GA), with predictable difficulties of tracheal intubation, as well as if the patient wishes
The limitations of the use of intravenous sedation in combination with local anesthesia are anatomical variants of SFM that are difficult for occluder implantation, as well as the patient's low tolerance to ECG in consciousness
Summary
Том 18, No 5, 2021 h t t p: //d o i.o r g /10. 212 9 2 / 2 078 - 5 6 5 8 -2 0 21-18 - 5 - 3 0 - 3 9. Цель: сравнение вариантов анестезиологического обеспечения – общей анестезии (ОА) и внутривенной седации при имплантации окклюдера ушка левого предсердия (УЛП). В исследование включено 120 пациентов из регистра имплантации окклюдеров УЛП НМИЦ кардиологии, которые разделены на две группы с учетом использованной тактики анестезиологического обеспечения: ОА (n = 100) и внутривенной седации (n = 20). Сочетанная внутривенная седация с местной анестезией является эффективной и достаточно безопасной методикой анестезиологического обеспечения имплантации окклюдера УЛП. Ограничениями применения внутривенной седации в сочетании с местной анестезией являются трудные для имплантации окклюдера анатомические варианты УЛП, а также низкая толерантность пациента к ЧПЭхоКГ в сознании. Ключевые слова: фибрилляция предсердий, кардиоэмболический инсульт, окклюдер ушка левого предсердия, анестезиологическое пособие Для цитирования: Певзнер Д. И. Сравнение вариантов анестезиологического обеспечения имплантации окклюдера ушка левого предсердия у пациентов с фибрилляцией предсердий // Вестник анестезиологии и реаниматологии.
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