Abstract

Aortic valve stenosis (AVS) is prevalent in 2-4% of the population greater than age 75. Historically, the definitive treatment for patients diagnosed with AVS involved a high-risk open-heart surgery for replacement of the aortic valve. Transcatheter aortic valve replacement (TAVR), a minimally invasive approach, is now the treatment of choice for high-risk patients with AVS. Variation in anesthetic modalities exist for management of TAVR in the operating room (OR). General anesthesia (GA) has been routinely utilized as the anesthetic technique for patients undergoing TAVR, however the hemodynamic and pulmonary risks that induction of GA presents for patients with AVS should be considered. Monitored anesthesia care (MAC) has recently been regarded as a potentially safer option for management of patients undergoing TAVR.

An 84-year-old female with a history of AVS presented for a TAVR. She received dexmedetomidine 1 mcg/kg IV for a total of 55 mcg before arrival to the OR. Throughout the case, the patient received an infusion of dexmedetomidine 1 mcg/kg/hr IV. Propofol 15 mg IV boluses were administered during times of stimulation such as TEE probe placement and femoral artery puncture. The patient required a norepinephrine 0.02 mcg/kg/min IV infusion throughout the case. After successful completion of the procedure, the patient was transported to the post-anesthesia care unit (PACU) on O2 3L/min via nasal cannula. Vital signs were within normal limits.

Author Details

Marlee Murphree, BSN and David Sanford, DNP, CRNA

Sigma Membership

Non-member

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Transcatheter Aortic Valve Replacement, Monitored Anesthesia Care, General Anesthesia

Advisor

Sanford, David

Degree

Doctoral-Other

Degree Grantor

Samford University

Degree Year

2023

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2023-02-01

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