Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.01.018
Brazilian Journal of Anesthesiology
Scientific Article

Inhalational anesthesia maintenance with the Janus facial mask for transcatheter aortic-valve replacement: a case series

Manutenção da anestesia inalatória com a máscara facial Janus para substituição de válvula aórtica transcateter: uma série de casos

Caetano Nigro Neto; Emerson Domingos da Costa; Francisco José Lucena Bezerra; Mariana Suete Guimarães Ruy; Jose Leonardo Izquierdo Saurith; João Henrique Zucco Viesi

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Abstract

Abstract Background and objectives Aortic stenosis is the most common type of heart valve disease. Percutaneous aortic valve replacement has become the alternative for patients considered at high risk for surgery. Controlled mechanical ventilation with tracheal intubation has been the choice for this type of procedure, however the use of noninvasive ventilation in cardiac patients has shown to be beneficial. Janus is a novel full-face mask that allows application of noninvasive ventilation support during anesthesia. Our main objective was to evaluate the feasibility of transcatheter aortic valve replacement with prolonged transesophageal echocardiographic monitoring under deep inhalational sedation delivered through a new mask for noninvasive ventilation. Methods A case series observational study that included five patients with critical aortic stenosis that underwent inhalational anesthesia with sevoflurane for transcatheter aortic valve replacement in a hybrid room of a teaching hospital. Standard monitors and bispectral index were used, followed by inhalational induction and placement of the Janus mask. Anesthesia was maintained with sevoflurane. Patients were transferred to intensive care unit after the procedure. Complications related to the mask use, transesofageal echocardiography accessibility and respiratory implications to the patients were recorded. Results All procedures were uneventful and no major complications were observed intraoperatively. One patient presented CO2 retention (50 mmHg) and sevoflurane leak around the central opening of the mask, both without clinical significance. Conclusions The use of inhalational anesthesia with the facial mask Janus is a safe and efficient alternative to general anesthesia with tracheal intubation for transcatheter aortic valve replacement and can easily accommodate the use of transesophageal echocardiography intraoperatively.

Keywords

Transcatheter aortic valve replacement, Aortic stenosis, Transesophageal echocardiogram, Noninvasive ventilation, Tracheal intubation, Volatile anesthetics

Resumo

Resumo Justificativa e objetivos A estenose aórtica é o tipo mais comum de doença valvular cardíaca. A substituição percutânea de válvula aórtica tornou-se a alternativa para pacientes cirúrgicos considerados de alto risco. A ventilação mecânica controlada com intubação traqueal tem sido a escolha para esse tipo de procedimento; porém, o uso de ventilação não invasiva em pacientes cardíacos mostrou ser benéfico. Janus é uma nova máscara facial que permite a aplicação de suporte à VNI durante a anestesia. Nosso objetivo primário foi avaliar a viabilidade da substituição transcateter de valva aórtica com monitoração ecocardiográfica transesofágica prolongada sob sedação inalatória profunda através de uma nova máscara para ventilação não invasiva. Métodos Estudo observacional de série de casos que incluiu cinco pacientes com estenose aórtica em fase crítica, submetidos à anestesia inalatória com sevoflurano para substituição transcateter de valva aórtica em uma sala híbrida de um hospital universitário. Monitores padrão e índice bispectral foram usados, seguidos de indução inalatória e colocação da máscara Janus. A anestesia foi mantida com sevoflurano. Os pacientes foram transferidos para a unidade de terapia intensiva após o procedimento. As complicações relacionadas ao uso da máscara, a acessibilidade da ecocardiografia transesofágica e as implicações respiratórias para os pacientes foram registradas. Resultados Todos os procedimentos transcorreram sem incidentes e não foram observadas complicações maiores no intraoperatório. Um paciente apresentou retenção de CO2 (50 mmHg) e vazamento de sevoflurano em torno da abertura central da máscara, ambos sem significância clínica. Conclusões O uso de anestesia inalatória com a máscara facial Janus é uma opção segura e eficiente à anestesia geral com intubação traqueal para substituição transcateter de valva aórtica e pode facilmente acomodar o uso de ecocardiografia transesofágica no intraoperatório.

Palavras-chave

Substituição de válvula aórtica transcateter, Estenose aórtica, Ecocardiograma transesofágico, Ventilação não invasiva, Intubação traqueal, Anestésicos voláteis

References

Carabello BA, Paulus WJ. Aortic stenosis. Lancet. 2009;373:956-66.

Nishimura RA, Otto CM, Bonow RO. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2438-88.

Makkar RR, Fontana GP, Jilaihawi H. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012;366:1696-704.

Ruggeri L, Gerli C, Franco A. Anesthetic management for percutaneous aortic valve implantation: an overview of worldwide experiences. HSR Proc Intensive Care Cardiovasc Anesth. 2012;4:40-6.

Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144:596-608.

Motloch LJ, Rottlaender D, Reda S. Local versus general anesthesia for transfemoral aortic valve implantation. Clin Res Cardiol. 2012;101:45-53.

Landoni G, Zangrillo A, Cabrini L. Noninvasive ventilation after cardiac and thoracic surgery in adult patients: a review. J Cardiothorac Vasc Anesth. 2012;26:917-22.

Guarracino F, Cabrini L, Baldassarri R. Non-invasive ventilation-aided transoesophageal echocardiography in high-risk patients: a pilot study. Eur J Echocardiogr. 2010;11:554-6.

Jakobsen CJ, Berg H, Hindsholm KB. The influence of propofol versus sevoflurane anesthesia on outcome in 10,535 cardiac surgical procedures. J Cardiothorac Vasc Anesth. 2007;21:664-71.

Landoni G, Rodseth RN, Santini F. Randomized evidence for reduction of perioperative mortality. J Cardiothorac Vasc Anesth. 2012;26:764-72.

Landoni G, Greco T, Biondi-Zoccai G. Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery. Br J Anaesth. 2013;111:886-96.

Xu R, Lu R, Jiang H. Meta-analysis of protective effect of sevoflurane on myocardium during cardiac surgery. Eur Rev Med Pharmacol Sci. 2014;18:1058-66.

Nigro Neto C, Costa E, Rossi R. Inhalation induction with sevoflurane in adult cardiac surgery patients. A case series. Heart Lung Vessel. 2014;6:8-12.

Leech CJ, Baba R, Dhar M. Spinal anaesthesia and non-invasive positive pressure ventilation for hip surgery in an obese patient with advanced chronic obstructive pulmonary disease. Br J Anaesth. 2007;98:763-5.

Michelet P, D’Journo XB, Seinaye F. Non-invasive ventilation for treatment of postoperative respiratory failure after oesophagectomy. Br J Surg. 2009;96:54-60.

Warren J, Sharma SK. Ventilatory support using bilevel positive airway pressure during neuraxial blockade in a patient with severe respiratory compromise. Anesth Analg. 2006;102:910-1.

Guarracino F, Gemignani R, Pratesi G. Awake palliative thoracic surgery in a high-risk patient: one-lung, non-invasive ventilation combined with epidural blockade. Anaesthesia. 2008;63:761-3.

Cabrini L, Plumari VP, Nobile L. Non-invasive ventilation in cardiac surgery: a concise review. Heart Lung Vessel. 2013;5:137-41.

Cabrini L, Savia I, Bevilacqua M. Continuous positive airway pressure during upper endoscopies: a bench-study on a novel device. J Cardiothorac Vasc Anesth. 2016;30:e43-5.

Ruppert V, Leurs LJ, Rieger J. Risk-adapted outcome after endovascular aortic aneurysm repair: analysis of anesthesia types based on EUROSTAR data. J Endovasc Ther. 2007;14:12-22.

Mayr NP, Michel J, Bleiziffer S. Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI). J Thorac Dis. 2015;7:1518-26.

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