[DEXMEDETOMIDINE SEDATION DURING TRANSCATHETER AORTIC VALVE IMPLANTATION.]

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Transcatheter aortic valve implantation (TAVI) is a critical procedure for aortic stenosis.
• Sedation and analgesia are vital for patient comfort and procedural success during TAVI.
• Optimizing sedation strategies can improve patient outcomes and reduce complications.

Purpose of the Study:

• To evaluate the efficacy and safety of dexmedetomidine for sedation and analgesia during TAVI with femoral access.
• To compare dexmedetomidine-induced sedation with midazolam-ketamine in high-risk patients undergoing TAVI.

Main Methods:

• A comparative study involving 34 high-risk patients with critical aortic stenosis undergoing TAVI via femoral access.
• Patients received either midazolam-ketamine or dexmedetomidine sedation under local anesthesia.
• Sedation depth was assessed using the Richmond agitation-sedation scale (RASS) and Ramsay scale; complication rates were monitored.

Main Results:

• Dexmedetomidine group showed significantly deeper sedation levels (RASS and Ramsay scales) compared to midazolam/ketamine.
• A significant decrease in rapid pacing episodes was observed in the dexmedetomidine group (p = 0.0005).
• No significant differences in complication incidence, operation duration, anesthesia duration, hospital stay, or ICU stay were found between groups.

Conclusions:

• Dexmedetomidine is a safe and effective sedative agent for TAVI with femoral access.
• It ensures deep sedation without compromising respiratory function and improves conditions for transesophageal echocardiography.
• Reduced rapid pacing episodes with dexmedetomidine may decrease delirium frequency in elderly TAVI patients.