title: General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study.
abstract: Reported data suggest that 99% of transfemoral, transcatheter aortic valve implantations in the UK are performed under general anaesthesia. This before-and-after study is the first UK comparison of conscious sedation vs. general anaesthesia for this procedure. Patients who underwent general anaesthesia received tracheal intubation, positive pressure ventilation, radial arterial and central venous access and urinary catheterisation. Anaesthesia was maintained with propofol or sevoflurane. Patients who received conscious sedation had a fascia iliaca and ilioinguinal nerve block and low-dose remifentanil infusion, without invasive monitoring or urinary catheterisation. Recruitment took place between August 2012 and July 2015, with a 6-month crossover period between November 2013 and June 2014. A total of 88 patients were analysed, evenly divided between the two groups. Patients receiving conscious sedation had a shorter anaesthetic time (mean (SD) 121 (28) min vs. 145 (41) min; p < 0.001) and recovery room time (110 (50) min vs. 155 (48) min; p = 0.001), lower requirement for inotropes (4.6% vs 81.8%; OR (95% CI) 0.1 (0.002-0.050); p < 0.001) and a lower incidence of malignant dysrhythmia (0% vs 11.4%; p = 0.020). Conscious sedation appears a feasible alternative to general anaesthesia for this procedure and is associated with a reduced requirement for inotropic support and improved efficiency.
authors.affiliation: Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK.
authors.forename: L F
authors.initials: LF
authors.lastname: Miles
authors.affiliation: School of Clinical Medicine, University of Cambridge, Papworth Hospital, Cambridge, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Joshi
authors.affiliation: Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK.
authors.forename: E H
authors.initials: EH
authors.lastname: Ogilvie
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK.
authors.forename: C G
authors.initials: CG
authors.lastname: Densem
authors.affiliation: Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK.
authors.forename: A A
authors.initials: AA
authors.lastname: Klein
authors.affiliation: Department of Interventional Cardiology, Papworth Hospital, Cambridge, UK.
authors.forename: M
authors.initials: M
authors.lastname: O'Sullivan
authors.affiliation: Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK.
authors.forename: G
authors.initials: G
authors.lastname: Martinez
authors.affiliation: Department of Cardiac Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: C D
authors.initials: CD
authors.lastname: Sudarshan
authors.affiliation: Department of Cardiac Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Abu-Omar
authors.affiliation: Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK.
authors.forename: J F
authors.initials: JF
authors.lastname: Irons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*
keywords: aortic stenosis; cardiology; conscious sedation; transcatheter aortic valve implantation