ABSTRACT
INTRODUCTION: Over the last two decades transcatheter aortic valve replacement (TAVR) has been approved for clinical use. The anaesthetic choice for this procedure is evolving. General anaesthesia was the predominant anaesthetic technique. Growing experience and advances in technology and economic considerations have led to an increasing interest in performing TAVR under monitored sedation. AIM: The assessment of monitored sedation, called cooperative sedation, involves pharmacologically mediated suppression of consciousness and preservation of verbal contact in response to stimulation as a safe method of anaesthesia for TAVR. MATERIAL AND METHODS: Sixty out of 63 TAVR patients with femoral access received monitored sedation. Dexmedetomidine was administered in most of such cases (46 patients). A questionnaire was also carried out by staff involved in performing TAVR procedures, with more than 5 years of experience in it, concerning the method of anaesthesia and perioperative care. RESULTS: Conversion to general anaesthesia was required in 10% of patients (6 cases), only one as a patient-related complication (hypercarbia). The questionnaire carried out showed that anaesthesia and postoperative care after TAVR are underestimated. CONCLUSIONS: The preliminary results regarding anaesthetic management in TAVR procedures demonstrate that monitored sedation is safe, provided that contraindications are observed.
ABSTRACT
The concept of early recovery after surgery (ERAS) consists of bundle interventions during the pre-, intra- and postoperative periods and team work. The ERAS, which is a multimodal strategy, enables one to limit the neurohumoral response to the surgery, maintain homeostasis, reduce the risk of complications, shorten the hospital stay, accelerate the return to everyday functioning, improve the patient's satisfaction, achieve a satisfactory quality of life and finally reduce the treatment costs and eliminate any redundant and ineffective practices. Almost every patient can be classified for the ERAS strategy except for patients undergoing urgent and emergency surgery. The necessity to give up ERAS can result from poor organisation and management. Moreover, the procedure itself can be the cause of the lack of adherence to the planned standard. It is necessary to use protocols and checklists. While fulfilling this doctrine, the anaesthesiologist becomes a perioperative specialist.
ABSTRACT
INTRODUCTION: Significant impairment of left ventricular function causes low cardiac output syndrome in the immediate postoperative period in 3-14% of patients undergoing surgery, increasing the mortality 15-fold. AIM: To assess the use of levosimendan in patients undergoing cardiac surgery in 2016. MATERIAL AND METHODS: The analysis included 14 patients: 3 (21.4%) women and 11 (78.6%) men aged 65.4 ±11.8 years. The mean value of left ventricular ejection fraction amounted to 20 ±6.25%. In 11 patients, levosimendan infusion was started immediately after the induction of anesthesia. Three patients received the agent during the early postoperative period due to low cardiac output syndrome refractory to conventional therapy. The dosage was modified within the range of 0.05-0.2 µg/kg/min. On the day of the surgery, all patients received continuous infusion of adrenaline and levonor. RESULTS: The cardiac index amounted to 2.8 ±0.71 l/m2 after several hours of infusion and 2.9 ±0.1 l/m2 the next morning. The first examination showed that the mean systemic vascular resistance was 1010 dyn/s-5 and the second: 940 ±100 dyn/s-5; mixed venous blood saturation amounted to 66 ±7.5% and 65.5 ±8%, respectively. Respectively, the mean concentration of lactates was 2.0 ±0.96 mmol/l and 1.8 ±0.24 mmol/l. Mechanical lung ventilation lasting more than 48 hours was required in 50% of the patients. Two patients with chronic kidney disease required bedside renal replacement therapy before the procedure. Two (14.3%) patients died. Nine (64.3%) patients were discharged home, and three were transferred to cardiac wards. CONCLUSIONS: Levosimendan therapy proved safe in the study group. The nature of the study and the small sample size preclude the formulation of detailed conclusions.
