Difference between revisions of "Transcatheter aortic valve replacement"

Transcatheter aortic valve replacement
Anesthesia type	MAC vs. GA
Airway	Natural airway vs. ETT
Lines and access	2 large bore PIV + art line (left preferred)
Monitors	Standard, ABP
	Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
	Article quality
Editor rating	In development
User likes	0

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Revision as of 12:52, 11 November 2021

Provide a brief summary of this surgical procedure and its indications here.

Preoperative management

Patient evaluation


System	Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

Arterial line prior to induction

Induction and airway management

Positioning

Supine, arms tucked

Maintenance and surgical considerations

For MAC cases, can consider either remifentanil 0.25mcg/kg/min titrated to effect or propofol 25mcg/kg/min titrated to effect

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Complete heart block, stroke, MI, aortic dissection, contrast induced nephropathy, perivalvular leaks

Valvular access site issues: Groin seromas, femoral artery dissection, thrombosis with lower extremity ischemia, retroperitoneal hematoma

Transapical approach: new onset MR, pericardial effusion, pneumothorax, late apical rupture

Procedure variants


	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

Top contributors: Olivia Sutton, Jessica, Tony Wang, David Leon, William Hsu and Chris Rishel

@@ Line 1: / Line 1: @@
+{{Infobox surgical procedure
+| anesthesia_type = MAC vs. GA
+| airway = Natural airway vs. ETT
+| lines_access = 2 large bore PIV + art line (left preferred)
+| monitors = Standard, ABP
+| considerations_preoperative =
+| considerations_intraoperative =
+| considerations_postoperative =
+}}
+Provide a brief summary of this surgical procedure and its indications here.
+== Preoperative management ==
+=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
+{| class="wikitable"
+|+
+!System
+!Considerations
+|-
+|Neurologic
+|
+|-
+|Cardiovascular
+|
+|-
+|Respiratory
+|
+|-
+|Gastrointestinal
+|
+|-
+|Hematologic
+|
+|-
+|Renal
+|
+|-
+|Endocrine
+|
+|-
+|Other
+|
+|}
+=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
+=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
+=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
+=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
+== Intraoperative management ==
+=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
+Arterial line prior to induction
+=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
+=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
+Supine, arms tucked
+=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
+For MAC cases, can consider either remifentanil 0.25mcg/kg/min titrated to effect or propofol 25mcg/kg/min titrated to effect
+=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
+== Postoperative management ==
+=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
+=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
+=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
+Complete heart block, stroke, MI, aortic dissection, contrast induced nephropathy, perivalvular leaks
+Valvular access site issues: Groin seromas, femoral artery dissection, thrombosis with lower extremity ischemia, retroperitoneal hematoma
+Transapical approach: new onset MR, pericardial effusion, pneumothorax, late apical rupture
+== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
+{| class="wikitable wikitable-horizontal-scroll"
+|+
+!
+!Variant 1
+!Variant 2
+|-
+|Unique considerations
+|
+|
+|-
+|Position
+|
+|
+|-
+|Surgical time
+|
+|
+|-
+|EBL
+|
+|
+|-
+|Postoperative disposition
+|
+|
+|-
+|Pain management
+|
+|
+|-
+|Potential complications
+|
+|
+|}
+== References ==
+[[Category:Surgical procedures]]