Aortic stenosis and non-cardiac surgery

Brown, Jane; Morgan‐Hughes, Nicholas J.

doi:10.1093/bjaceaccp/mki001

Cited by 120 publications

(21 citation statements)

References 3 publications

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“…Hypotension leads to myocardial ischaemia and a downward spiral of reduced contractility, causing further falls in blood pressure and coronary perfusion. 8 It makes meticulous haemodynamic monitoring essential. To facilitate this, the left radial artery was cannulated under local anaesthesia before administering spinal anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Geriatric Anaesthesia for Centenarians- A Challenging, Learning Experience!

Hariharan¹,

Nagpal²,

Bharti³

et al. 2019

Journal of the Indian Academy of Geriatrics

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With improving healthcare facilities, the geriatric population in India is on the rise. Anaesthesia in the geriatric age group poses many challenges to the peri-operative physician because of the decreased functional reserve and various comorbidities associated with advanced age. In addition to that, there is greater risk of post-operative cognitive dysfunction and delirium. Anaesthesia in patients above 100 years is a sub-speciality in itself, with several special considerations. We, hereby present the case of a 102-year-old female patient with severe aortic stenosis posted for left-sided dynamic hip screw fixation on an emergency basis under low dose, unilateral spinal anaesthesia, supplemented with slow and graded epidural anaesthesia.

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Section: Discussionmentioning

confidence: 99%

Geriatric Anaesthesia for Centenarians- A Challenging, Learning Experience!

Hariharan¹,

Nagpal²,

Bharti³

et al. 2019

Journal of the Indian Academy of Geriatrics

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“…Moreover, patients with underlying valve disease from PA catheterisation, due to the potential arrhythmogenic risk , were not studied in one recent prospective study. Such reports in the literature have almost certainly led to the common perception that PA catheterisation in such patients is associated with an unacceptably high risk, except immediately before open heart surgery with cardiopulmonary bypass .…”

Section: Discussionmentioning

confidence: 99%

Arrhythmogenic risk of pulmonary artery catheterisation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Bergmann

Großwendt

Konorza³

et al. 2012

Anaesthesia

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SummaryMany clinicians consider severe aortic stenosis to be a contraindication to pulmonary artery catheterisation, except during open heart surgery with cardiopulmonary bypass. This is due to the perceived high risk of arrhythmia, although the true incidence of ventricular tachycardia and fibrillation remains unclear. We conducted a retrospective study to estimate the incidence of severe arrhythmias during pulmonary artery catheterisation in 380 patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation. Ventricular fibrillation was seen in only one patient (0.26%), and this was successfully terminated by external defibrillation. No episodes of ventricular tachycardia were recorded and there were also no arrhythmias during removal of the catheter. We have therefore concluded that pulmonary artery catheterisation in patients with severe aortic stenosis is not associated with a high incidence of ventricular fibrillation or tachycardia, allowing pulmonary artery pressure monitoring to be performed relatively safely in such patients.

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“…An increasing proportion of ED patients in the developed world are elderly. Undiagnosed aortic stenosis can lead to catastrophic operative consequences if a patient requires induction for theatre or other reasons – these patients require invasive blood pressure monitoring, avoidance of the peripheral vasodilation caused by neuraxial techniques, and careful selection of pharmacological agents . 2D findings including calcification and restricted cusp movement, turbulence of flow on colour Doppler, and secondary signs such as left ventricular hypertrophy (LVH) can provide a large amount of information regarding aortic valve anatomy.…”

Section: Valvulopathiesmentioning

confidence: 99%

Expanding our FoCUS: the utility of advanced echocardiography in the emergency department

Henry

Haji

2019

Australas J Ultrason Med

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Point-of-care ultrasound (POCUS) use is widespread amongst emergency physicians (EPs). Many sonographic modalities have proven useful in the emergency department (ED), including basic echocardiography. Progressing to more advanced echocardiography allows for improved accuracy when making time-critical diagnoses and management decisions, particularly among the sickest patients. Acquisition of this skill set by EPs is feasible and enhances patient care.

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Aortic stenosis and non-cardiac surgery

Cited by 120 publications

References 3 publications

Geriatric Anaesthesia for Centenarians- A Challenging, Learning Experience!

Geriatric Anaesthesia for Centenarians- A Challenging, Learning Experience!

Arrhythmogenic risk of pulmonary artery catheterisation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Expanding our FoCUS: the utility of advanced echocardiography in the emergency department

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