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Anestesia general versus sedación para implante transcatéter de válvula aórtica: estudio retrospectivo en Hospital Colombiano

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dc.contributor.advisorMontes Romero, Félix Ramón
dc.contributor.advisorDurán-Torres, Felipe
dc.creatorHurtado Peña, Pedro Arturo
dc.creator.degreeEspecialista en Anestesia Cardiotorácicaspa
dc.creator.degreetypeFull timespa
dc.date.accessioned2020-08-04T16:57:17Z
dc.date.available2020-08-04T16:57:17Z
dc.date.created2020-07-31
dc.descriptionIntroducción: El TAVI surge como alternativa en el tratamiento de pacientes con estenosis aórtica severa sintomática, con riesgo quirúrgico prohibitivo o alto. En Colombia no hay estudios que muestren los beneficios o desventajas de la sedación en pacientes llevados a TAVI. El objetivo del presente estudio es comparar los tiempos de estancia intrahospitalaria y los desenlaces clínicos obtenidos en pacientes con estenosis aórtica severa o disfunción protésica aórtica que son llevados a TAVI bajo anestesia general con los encontrados en pacientes llevados a TAVI bajo sedación. Metodología: Estudio de cohorte retrospectivo en pacientes llevados a TAVI por vía transfemoral en la Fundación Cardioinfantil, entre el período 2016 - 2020 bajo anestesia general o sedación. Se evaluaron los tiempos de estancia en UCI y estancia hospitalaria, así como los desenlaces medidos por el VARC. Resultados: 158 procedimientos fueron incluidos, 82 (51.8%) bajo sedación y 76 (48.2%) bajo anestesia general. Estancia en UCI de 1.68 días en grupo sedados (1.4 a 1.9 IC 95%) vs 2.37 días para grupo de anestesia general (2.0-2.7 IC95%) (p = 0.002). Estancia hospitalaria posterior a TAVI de 3.37 en grupo sedación (2.9-3.8 IC95%) vs 4.38 días en el grupo de anestesia general (3.8-5.0 IC95%) (p = 0.009). No se identificaron diferencias en el VARC. Conclusiones: La implementación de la sedación en pacientes sometidos a TAVI transfemoral, se asocia a la disminución del tiempo en UCI y en estancia hospitalaria postoperatoria. No se evidenciaron diferencias en la incidencia de complicaciones postoperatorias considerados en el VARC.spa
dc.description.abstractIntroduction: Transcatheter aortic valve implantation (TAVI) is recommended in patients with severe symptomatic aortic stenosis with prohibitive and high surgical risk. It is also an alternative in patients with intermediate surgical risk. Despite the growth in the number of TAVI procedures performed, the optimal anesthetic management has not been established. At our institution, TAVI was conventionally performed under general anesthesia (GA), yet in December 2017, a sedation management protocol was implemented. The objective of this study was to compare postinterventional outcomes of sedation with those of GA in patients undergoing transfemoral TAVI. Methods: This was a single-center, retrospective, before-after study. All consecutive patients who underwent transfemoral TAVI from January 2016 through March 2020 were stratified into two groups according to whether they received GA (before December 2017) or sedation (after December 2017) during the procedure. The primary endpoints were intensive care unit (ICU) and post-procedural hospital length of stays (LOS). Secondary endpoints were registered according to the Valve Academic Research Consortium-2 (VARC-2) criteria. In addition, the incidence of vasopressor use, procedural time, and anesthesia time was recorded. Data were analyzed by unpaired t-test with Welch´s correction, Fisher´s exact test or Chi-square as appropriate. P < 0.05 was considered statistically significant. Results: A total of 158 patients (53% male, mean age 79 years) underwent transfemoral TAVI under sedation (n = 82) or GA (n =76). Baseline characteristics are shown in Table 1. Seven patients (8.5%) in the sedation group required conversion to GA. Administration of sedation was associated with a significant decrease in UCI (1.7 vs 2.4 days, p = 0.002) and post-procedural hospital (3.4 vs 4.4 days, p = 0.009) LOS (Figure 1). The sedation group had a significantly shorter anesthesia time and less vasopressor requirement. Procedural time and VARC-2 endpoints were not significantly different (Table 1). Conclusions: Implementation of a sedation protocol for patients undergoing transfemoral TAVI was associated with improved ICU and hospital LOS. The incidence of important clinical endpoints was not affected by the anesthesia technique.spa
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_25838
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/25838
dc.language.isospaspa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentEscuela de Medicina y Ciencias de la Saludspa
dc.publisher.programEspecialización en Anestesia Cardiotorácicaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
dc.rights.licenciaEL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. Para el correcto ejercicio de mi derecho de habeas data cuento con la cuenta de correo habeasdata@urosario.edu.co, donde previa identificación podré solicitar la consulta, corrección y supresión de mis datos.spa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectAnestesia generalspa
dc.subjectSedaciónspa
dc.subjectTAVIspa
dc.subjectTransfemoralspa
dc.subject.ddcVarias ramas de la medicina, Cirugíaspa
dc.subject.ddcFarmacología & terapéuticaspa
dc.subject.keywordGeneral anesthesiaspa
dc.subject.keywordSedationspa
dc.subject.keywordTAVIspa
dc.titleAnestesia general versus sedación para implante transcatéter de válvula aórtica: estudio retrospectivo en Hospital Colombianospa
dc.title.TranslatedTitleGeneral anesthesia versus sedation for transcatheter aortic valve implant: retrospective study at Colombian Hospitaleng
dc.typemasterThesiseng
dc.type.documentDescriptivo observacional retrospectivospa
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de gradospa
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