Anaesthesia-related complications and side-effects in TAVI: a retrospective study in Germany

Goldfuss, Sophia; Wittmann, Sigrid; Würschinger, Fabian; Bitzinger, Diane; Seyfried, Timo; Holzamer, Andreas; Fischer, Marcus; Camboni, Daniele; Sinner, Barbara; Zausig, York

doi:10.1136/bmjopen-2018-025825

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Tissue trauma, pain perception, and psychological emotion will activate hypothalamus-pituitary-adrenal axis and sympathetic nervous system, triggering stress response, thereby reducing the perioperative stress response of patients, which is conducive to patients' recovery and can reduce the occurrence of potential complications [ 18 , 19 ]. Evidence has shown that appropriate depth of anesthesia can reduce the stress response of patients undergoing surgery and improve the hemodynamic stability of patients [ 20 , 21 ]. The results of this study revealed that at T1 and T2, the MAP value was higher and the CVP value was lower in NT group compared with group C, and higher CRP, IL-6, and Cor were determined in NT group at T1-T3.…”

Section: Discussionmentioning

confidence: 99%

Influence of Narcotrend-Assisted Anesthesia In-Depth Monitor on Cognitive Impairment of Elderly Patients under General Anesthesia

Zhang

Liu

2022

Computational and Mathematical Methods in Medicine

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Objective. This research is designed to probe into the influence of Narcotrend- (NT-) assisted anesthesia in-depth monitor on cognitive impairment of elderly patients under general anesthesia (GA). Methods. One hundred and forty-four elderly patients with GA in our hospital from October 2020 to April 2021 were randomized into two groups, namely, NT group (supervised anesthesia under NT monitoring) and group C (anesthesia according to doctors’ experience). The heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) were recorded before surgery (T0), at the beginning of surgery (T1), at the end of surgery (T2), and 1 day after surgery (T3). Serum of patients was obtained at these four time points for measurements of C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol (Cor) levels using the enzyme-linked immunosorbent assay (ELISA). The alterations in cognitive function pre- and post-anesthesia were assessed using the mini-mental state examination (MMSE), and adverse events (AEs) during anesthesia recovery, postoperative recovery, and dosage of anesthetics were recorded. Results. At T1 and T2, MAP was higher and CVP was lower in NT group, versus group C. NT group presented higher CRP, IL-6, and Cor than group C at T1-T3. MMSE scores were higher in TN group than in group C at 12, 24, and 48 h after surgery. The incidence rates of postoperative cognitive dysfunction (POCD) and total AEs in group C were noticeably higher than those in NT group. Compared with group C, the time of anesthesia recovery, extubation, and postanesthesia care unit (PACU) residence in NT group reduced remarkably. Conclusions. NT has little effect on the physical condition of elderly patients under GA, and can reduce the dosage of narcotic drugs and promote the recovery of patients from anesthesia, which has high clinical value.

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Section: Discussionmentioning

confidence: 99%

Influence of Narcotrend-Assisted Anesthesia In-Depth Monitor on Cognitive Impairment of Elderly Patients under General Anesthesia

Zhang

Liu

2022

Computational and Mathematical Methods in Medicine

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“…The valve and anesthesia comparisons were published separately in two journals, 12,13 and both were included as a complete study in the meta‐analysis. The majority of the included studies were observational (33 prospective studies, 14–46 28 retrospective studies, 47–74 and 4 studies with unknown nature 75–78 ), with only four RCTs 12,13,79–81 . The number of included patients varied widely, ranging from 25 to 170,521 per study.…”

Section: Resultsmentioning

confidence: 99%

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

Chu

Han

et al. 2022

J American Geriatrics Society

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Aims To perform an updated systematic review and meta‐analysis of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR). Methods We conducted a systematic literature search of PubMed, Embase, and Cochrane Library databases from the time of the first human TAVR procedure in 2002 until December 24, 2021, which was supplemented by manual searches of bibliographies. Data were collected on incidence rates, risk factors, and/or associated mortality of POD after TAVR. Pooled analyses were conducted using random effects models to yield mean differences, odds ratios, hazard ratios, and risk ratios, with 95% confidence intervals. Results A total of 70 articles (69 studies) comprising 413,389 patients were included. The study heterogeneity was substantial. The pooled mean incidence of POD after TAVR in all included studies was 9.8% (95% CI: 8.7%–11.0%), whereas that in studies using validated tools to assess for delirium at least once a day for at least 2 consecutive days after TAVR was 20.7% (95% CI: 17.8%–23.7%). According to the level of evidence and results of meta‐analysis, independent preoperative risk factors with a high level of evidence included increased age, male sex, prior stroke or transient ischemic attack, atrial fibrillation/flutter, weight loss, electrolyte abnormality, and impaired Instrumental Activities of Daily Living; intraoperative risk factors included non‐transfemoral access and general anesthesia; and acute kidney injury was a postoperative risk factor. POD after TAVR was associated with significantly increased mortality (pooled unadjusted RR: 2.20, 95% CI: 1.79–2.71; pooled adjusted RR: 1.62, 95% CI: 1.25–2.10), particularly long‐term mortality (pooled unadjusted HR: 2.84, 95% CI: 1.91–4.23; pooled adjusted HR: 1.88, 95% CI: 1.30–2.73). Conclusions POD after TAVR is common and is associated with an increased risk of mortality. Accurate identification of risk factors for POD after TAVR and implementation of preventive measures are critical to improve prognosis.

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“…Furthermore, the incidence of POD was rather low. The presumed number of participants was calculated based on the incidence of POD previously described in our TAVR population [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative suggestions to prevent postoperative delirium in patients undergoing transaortic valvular replacement: a randomized placebo-controlled trial

et al. 2023

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Background Postoperative delirium (POD) is a serious complication following anaesthesia and surgery and significantly influences postoperative outcome especially in the elderly population. Intraoperative music and positive suggestions influence postoperative outcomes by attenuating analgesic demand and increasing patient satisfaction. Aims Here, we examined the effect of intraoperative music and positive suggestions on the development of POD in aged patients undergoing transcatheter aortic valve replacement (TAVR) procedure under general anaesthesia. Methods For this randomized placebo-controlled study, eligible patients without cognitive deficit, indicated by a MMSE < 10 points, were anesthetized using remifentanil and sevoflurane. Anaesthetic depth was guide with bispectral index. An audiotape with positive suggestions was applied from a MP3 player via headphones. POD, pain and PONV was assessed. CAM-ICU and Nu-DESC were done twice daily for the first 5 days. Results Of 140 patients 118 patients could be analysed (57 male, 80.6 ± 5.1 years). POD was diagnosed in 16 patients (12.7%). POD was significantly more often observed in male (12, 21.1%) than in female (4, 6.6%, p = 0.02) and in patients with a low MMSE (23.6 ± 4.5 vs. 26.8 ± 2.8, p = 0.001). Anaesthetic depth did not influence the incidence of POD. Intraoperative music and suggestions did not affect the rate of POD, pain, analgesic requirement or PONV. Discussion In patients undergoing TAVR male sex and low MMSE scoring are associated with an increase in POD. Conclusions Intraoperative music and positive suggestions do not influence the incidence of POD in this patient group. Study registration DRKS: 00024444, start of registration: 4.02.202, final registration: 17.09.2021

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Anaesthesia-related complications and side-effects in TAVI: a retrospective study in Germany

Cited by 6 publications

References 31 publications

Influence of Narcotrend-Assisted Anesthesia In-Depth Monitor on Cognitive Impairment of Elderly Patients under General Anesthesia

Influence of Narcotrend-Assisted Anesthesia In-Depth Monitor on Cognitive Impairment of Elderly Patients under General Anesthesia

Postoperative delirium after transcatheter aortic valve replacement: An updated systematic review and meta‐analysis

Intraoperative suggestions to prevent postoperative delirium in patients undergoing transaortic valvular replacement: a randomized placebo-controlled trial

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