Difference between revisions of "Transcatheter aortic valve replacement"
From WikiAnesthesia
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=== 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. --> === | === 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. --> === | ||
Type and Cross 2 units of pRBCs | |||
=== 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. --> === | === 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. --> === | ||
Often done in a remote anesthesia setting. | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. 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. --> === | ||
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
2 PIVs: one for infusion. one for push line. | |||
If doing MAC: do not need to place an invasive A-line. Cardiologists will place a femoral and radial A-line that will monitor aortic and LV pressures; these can be used intra-op by the anesthesia team to monitor BP. Can use a non-invasive a-line such as a clear-sight if available. | |||
If doing GA, place 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. --> === | === 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. --> === | ||
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=== 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. --> === | === 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 | For MAC cases, can consider starting with remifentanil 0.02mcg/kg/min titrated to effect +/- propofol 20mcg/kg/min titrated to effect. | ||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
== Postoperative management == | == Postoperative management == | ||
Revision as of 16:09, 20 January 2022
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 | |
| User likes | 0 |
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
Type and Cross 2 units of pRBCs
Operating room setup
Often done in a remote anesthesia setting.
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
2 PIVs: one for infusion. one for push line.
If doing MAC: do not need to place an invasive A-line. Cardiologists will place a femoral and radial A-line that will monitor aortic and LV pressures; these can be used intra-op by the anesthesia team to monitor BP. Can use a non-invasive a-line such as a clear-sight if available.
If doing GA, place arterial line prior to induction.
Induction and airway management
Positioning
Supine, arms tucked
Maintenance and surgical considerations
For MAC cases, can consider starting with remifentanil 0.02mcg/kg/min titrated to effect +/- propofol 20mcg/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