A comparative study between propofol and dexmedetomidine as sedative agents during performing transcatheter aortic valve implantation.
OBJECTIVE
The type of sedative drugs could play a major role in providing hemodynamic stability which is crucial during transcatheter aortic valve implantation (TAVI) procedure. The aim of this study is to compare propofol with dexmedetomidine for conscious sedation during TAVI.


METHODS
A prospective randomized pilot study.


METHODS
Fifty patients with a mean age of 74years, American Society of Anesthesiologists 3-4, complaining from severe aortic stenosis were enrolled in this study to undergo TAVI.


METHODS
The propofol group (group P; n=25) received a bolus dose of 0.5mg/kg propofol followed by a continuous intravenous infusion of propofol at a rate of 30 to 50μg kg(-1) min(-1), and the dexmedetomidine group (group D; n=25) received dexmedetomidine at a loading dose of 1μg/kg and then a continuous intravenous infusion of dexmedetomidine at a rate of 0.5μg kg(-1) h(-1).


METHODS
Heart rate, mean arterial blood pressure, number of phenylephrine boluses, oxygen saturation, sedation, and satisfaction scores were measured just after the start of infusion of the sedation drugs and at the end of the procedure. Postoperative complications were also recorded.


RESULTS
There was a statistically significant reduction in the heart rate in group D in comparison to group P where it was 67.28±6.9beats/min in the first group in comparison to 78±6.9beats/min in the last one (P<.001). The mean arterial blood pressure was statistically significant lower in group D in comparison to group P (58.12±5.4mm Hg in group D vs 68.24±11.4mm Hg in group P; P<.001). Also, the number of phenylephrine boluses was higher in group D than in group P (36.5±7.17 in group D vs 20.6±2.07 in group p; P<.001). No difference between the 2 groups regarding oxygen saturation, sedation, pain, satisfaction scores, and postoperative complications.


CONCLUSIONS
During TAVI, dexmedetomidine may be associated with significant hypotension and bradycardia rather than propofol.
Anesthesia Department, Cairo University, Giza, Egypt. Electronic address: mohamedkhalil404@hotmail.com.
Mohamed
M
Khalil
Anesthesia Department, Cairo University, Giza, Egypt.
Ahmed
A
Al-Agaty
Anesthesia Department, Cairo University, Giza, Egypt.
Osama
O
Asaad
Critical Care Department, Cairo University, Giza, Egypt.
Mohsen
M
Mahmoud
Critical Care Department, Cairo University (Beni-Suef division), Giza, Egypt.
Amr S
AS
Omar
Critical Care Department, Cairo University, Giza, Egypt.
Ahmed
A
Abdelrazik
Cardiology Department, Ain-Shams University, Giza, Egypt.
Mohamed
M
Mostafa
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D020927:Dexmedetomidine / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D010865:Pilot Projects; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol
Conscious sedation; Dexmedetomidine; Propofol; TAVI