A comparative study between propofol and dexmedetomidine as sedative agents during performing transcatheter aortic valve implantation

Objective: The type of sedative drugs could play a major role in providing hemodynamic stability which is crucial during transcatheter aortic valve implantation (TAVI) procedure. The aim of this study is to compare propofol with dexmedetomidine for conscious sedation during TAVI. Design: A prospective randomized pilot study. Patients: Fifty patients with a mean age of 74 years, American Society of Anesthesiologists 3-4, complaining from severe aortic stenosis were enrolled in this study to undergo TAVI. Interventions: The propofol group (group P; n = 25) received a bolus dose of 0.5 mg/kg propofol followed by a continuous intravenous infusion of propofol at a rate of 30 to 50 mu g kg(-1) min(-1),and the dexmedetomidine group (group D; n = 25) received dexmedetomidine at a loading dose of 1 mu g/kg and then a continuous intravenous infusion of dexmedetomidine at a rate of 0.5 mu g kg(-1) h(-1). Measurements: Heart rate, mean arterial blood pressure, number of phenylephrine boluses, oxygen saturation, sedation, and satisfaction scores were measured just after the start of infusion of the sedation drugs and at the end of the procedure. Postoperative complications were also recorded. Results: There was a statistically significant reduction in the heart rate in group D in comparison to group P where it was 67.28 +/- 6.9 beats/min in the first group in comparison to 78 +/- 6.9 beats/min in the last one (P < .001). The mean arterial blood pressure was statistically significant lower in group Din comparison to group P (58.12 +/- 5.4 mm Hg in group D vs 68.24 +/- 11.4 mm Hg in group P; P < .001). Also, the number of phenylephrine boluses was higher in group D than in group P (36.5 +/- 7.17 in group D vs 20.6 +/- 2.07 in group p; P < .001). No difference between the 2 groups regarding oxygen saturation, sedation, pain, satisfaction scores, and postoperative complications. Conclusion: During TAVI, dexmedetomidine may be associated with significant hypotension and bradycardia rather than propofol. (C) 2016 Elsevier Inc. All rights reserved.