Journal of cardiothoracic and vascular anesthesia · 2018
The Incidence of Dysphagia Among Patients Undergoing TAVR With Either General Anesthesia or Moderate Sedation.
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Mukdad Laith, Kashani Rustin, Mantha Aditya, Sareh Sohail, Mendelsohn Abie, Benharash Peyman
Аннотация
OBJECTIVES: To determine the incidence of dysphagia and aspiration pneumonia following transcatheter aortic valve replacement (TAVR) performed with either general anesthesia (GA) or moderate sedation (MS).
DESIGN: Retrospective study.
SETTING: Tertiary care university hospital.
PARTICIPANTS: One hundred ninety-seven patients undergoing TAVR from 2012 to 2016 INTERVENTIONS: After Institutional Review Board approval, 197 consecutive patients undergoing TAVR from 2012 to 2016 at the authors' institution were identified for analysis and placed into groups depending on method of anesthesia received (GA: n = 139 v MS: n = 58). Groups then were compared with respect to baseline characteristics, operative details, primary outcome variables (dysphagia, pneumonia), and secondary outcome variables.
MEASUREMENT AND MAIN RESULTS: Any patient who failed the institution's postprocedure bedside swallow test subsequently underwent a fiberoptic endoscopic evaluation of swallowing test, confirming the diagnosis of dysphagia. GA patients were significantly more likely to develop dysphagia, which occurred in 10 GA patients and no MS patients (p = 0.04). MS patients also were found to have significantly reduced operative durations and spent less time in the intensive care unit and hospital (p < 0.001).
CONCLUSIONS: Patients who underwent TAVR with moderate sedation were less likely to develop dysphagia. Use of MS may be particularly suitable in patients predisposed to swallowing dysfunction.
DESIGN: Retrospective study.
SETTING: Tertiary care university hospital.
PARTICIPANTS: One hundred ninety-seven patients undergoing TAVR from 2012 to 2016 INTERVENTIONS: After Institutional Review Board approval, 197 consecutive patients undergoing TAVR from 2012 to 2016 at the authors' institution were identified for analysis and placed into groups depending on method of anesthesia received (GA: n = 139 v MS: n = 58). Groups then were compared with respect to baseline characteristics, operative details, primary outcome variables (dysphagia, pneumonia), and secondary outcome variables.
MEASUREMENT AND MAIN RESULTS: Any patient who failed the institution's postprocedure bedside swallow test subsequently underwent a fiberoptic endoscopic evaluation of swallowing test, confirming the diagnosis of dysphagia. GA patients were significantly more likely to develop dysphagia, which occurred in 10 GA patients and no MS patients (p = 0.04). MS patients also were found to have significantly reduced operative durations and spent less time in the intensive care unit and hospital (p < 0.001).
CONCLUSIONS: Patients who underwent TAVR with moderate sedation were less likely to develop dysphagia. Use of MS may be particularly suitable in patients predisposed to swallowing dysfunction.