経カテーテル大動脈弁留置術における鎮静プロトコル：ケタミン・プロポフォール併用療法 vs レミフェンタニル・デクスメデトミジン併用療法に関するランダム化比較試験
Anna Castellari1, Matteo Lucchelli1, Mattia Gomarasca1
1S.C. Rianimazione e Anestesia Legnano, ASST Ovest Milanese, Legnano, Italy.
Objectives:
To compare efficacy and safety of two different sedation protocols during Transcatheter Aortic Valve Replacement (TAVR); Ketamine and Propofol (KETOFOL) versus Remifentanil and Dexmedetomidine (REMIDEX).
Design:
Monocentric, prospective, randomized and controlled trial.
Setting:
University hospital.
Participants:
231 patients were enrolled in the trial. 198 patients were included in the final analysis.
Interventions:
Patients enrolled underwent procedural sedation according to one of the two possible drug combinations, KETOFOL vs REMIDEX, assigned through randomization. During the procedure intervention times and clinical parameters were recorded. After the procedure incidence of postoperative adverse events were recorded.
Measurements And Main Results:
REMIDEX group showed a higher trend in the raw incidence of respiratory acidosis (67.7 % vs 54.3 %). The correlation was confirmed in the multivariate logistic regression analysis, with an increased risk of developing respiratory acidosis in the REMIDEX group (OR 1.864 %, 95 % CI 1.014-3.427). Patients in the REMIDEX group showed significantly longer induction times. REMIDEX group required a greater number of pharmacological adjustments, had a higher incidence of intraoperative agitation, and more episodes of desaturation. No other differences were observed in any of the other intraoperative or postoperative safety indicators.
Conclusions:
Both protocols showed a low and comparable incidence of cardiovascular adverse events and postoperative complications such as POD and POCD. KETOFOL protocol appears to offer greater sedative stability and seems to be more protective regarding the incidence of respiratory adverse events.
