The Importance of Conscious Sedation for Life-Saving Valve Procedures in Patients With Rheumatic Heart Disease From Low- to Middle-Income Countries.

Abstract

BACKGROUND:

Severe valve disease, which requires intervention, remains strongly associated with mortality in patients with rheumatic heart disease. Percutaneous mitral commissurotomy (PMC) is the procedure of choice for the treatment of patients with isolated or predominantly rheumatic mitral stenosis. This procedure has been performed under sedation to avoid the potential effects of general anesthesia on intracardiac pressure measurements. However, there are limited data on sedation during PMC, especially using easily available medications in low- and middle-income countries.

OBJECTIVES:

This study was designed to evaluate the efficacy and hemodynamic effects of conscious sedation during PMC in patients with significant mitral stenosis.

METHODS:

This study prospectively enrolled 23 patients who underwent PMC with the Inoue balloon technique for hemodynamically significant mitral stenosis. For conscious sedation, midazolam 25 μg/kg and fentanyl 1 μg/kg were administered, and 5 min after the infusion, the level of sedation was evaluated by Ramsay sedation scale. A range of invasive hemodynamic measurements, including cardiac output and pulmonary artery pressures, were recorded before and immediately after sedation.

RESULTS:

The mean age was 44.9 ± 10.8 years, and 19 patients (83%) were women. After sedation, the majority of patients were in categories 2 and 3 of the Ramsay sedation scale (cooperative, orientated, tranquil, and responding to commands). Oxygen saturation dropped from an average of 98.5% to 96.0% without supplementary oxygen. Left ventricular systolic pressure and central aortic pressures decreased after sedation. However, none of the other parameters changed significantly after sedation, including pulmonary artery pressures, pulmonary vascular resistance, and cardiac index.

CONCLUSIONS:

This simple model of conscious sedation was able to promote anxiolysis, analgesia, and comfort for the procedure without serious hemodynamic effects, which can be a reasonable choice in developing countries.

• Authors: Marta Eugenia Alcici, Lucas Lodi-Junqueira, Guilherme Rafael Sant'Anna Athayde, Juliana Rodrigues Soares, Diogo Antônio Gomes Tiago, Priscila Lima Tavares, Gabriel Prado Saad, Igor Ferreira de Sales, Emmy Okello, Joselyn Rwebembera, William A M Esteves, Maria Carmo P Nunes
• Journal: Global heart (Glob Heart) Vol. 14 Issue 3 Pg. 311-316 (09 2019) ISSN: 2211-8179 [Electronic] England
• PMID: 31451239 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

Topics

• Adult
• Conscious Sedation
• Developing Countries
• Endovascular Procedures (methods)
• Female
• Hemodynamics (physiology)
• Humans
• Male
• Mitral Valve (surgery)
• Mitral Valve Stenosis (physiopathology, surgery)
• Prospective Studies
• Rheumatic Heart Disease (physiopathology, surgery)
• Treatment Outcome