Journal of cardiothoracic and vascular anesthesia · 2020
Ultrasound-Guided Intermediate Cervical Plexus Block for Transcarotid Transcatheter Aortic Valve Replacement.
СтатьяНазвание и аннотация: Перевод в очереди
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Colegrave Nora, Mascitti Paola, Zannis Konstandinos, Miceli PierLuigi, Veugeois Aurélie, Caussin Christophe, Philip Ivan
Аннотация
OBJECTIVE: To report the authors' initial experience of transcarotid transcatheter aortic valve replacement (TAVR) managed with ultrasound-guided intermediate cervical plexus block.
DESIGN: A single-center prospective study.
SETTING: A teaching hospital in Paris, France.
PARTICIPANTS: All consecutive patients undergoing a transcarotid TAVR were included.
INTERVENTIONS: The ultrasound-guided intermediate cervical plexus block was performed in 28 of 31 patients. In 3 patients, the procedure was scheduled under general anesthesia: 2 because of failure of previous transfemoral procedures under local anesthesia, and 1 for an emergency procedure in a pulmonary edema context.
MEASUREMENTS AND MAIN RESULTS: Anesthesia and all perioperative parameters were recorded, as well as any complications after the procedure. Twenty-eight patients were managed with intermediate cervical plexus block and light sedation without any anesthesia-related complication. No conversion to general anesthesia was required. The use of vasopressor was only required in 11% of the patients. In 2 patients, a loss of consciousness after the common carotid artery cross-clamping test occurred, leading to the use of a temporary femoral-carotid shunt; no other change in consciousness was recorded during the procedure.
CONCLUSIONS: Ultrasound-guided intermediate cervical plexus block appeared to be an alternative anesthetic technique for carotid TAVR, providing adequate surgical conditions, continuous neurologic monitoring, and arterial pressure stability.
DESIGN: A single-center prospective study.
SETTING: A teaching hospital in Paris, France.
PARTICIPANTS: All consecutive patients undergoing a transcarotid TAVR were included.
INTERVENTIONS: The ultrasound-guided intermediate cervical plexus block was performed in 28 of 31 patients. In 3 patients, the procedure was scheduled under general anesthesia: 2 because of failure of previous transfemoral procedures under local anesthesia, and 1 for an emergency procedure in a pulmonary edema context.
MEASUREMENTS AND MAIN RESULTS: Anesthesia and all perioperative parameters were recorded, as well as any complications after the procedure. Twenty-eight patients were managed with intermediate cervical plexus block and light sedation without any anesthesia-related complication. No conversion to general anesthesia was required. The use of vasopressor was only required in 11% of the patients. In 2 patients, a loss of consciousness after the common carotid artery cross-clamping test occurred, leading to the use of a temporary femoral-carotid shunt; no other change in consciousness was recorded during the procedure.
CONCLUSIONS: Ultrasound-guided intermediate cervical plexus block appeared to be an alternative anesthetic technique for carotid TAVR, providing adequate surgical conditions, continuous neurologic monitoring, and arterial pressure stability.