Journal
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
Volume 32, Issue 4, Pages 1570-1577Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.jvca.2017.12.018
Keywords
aortic stenosis; transcatheter aortic valve replacement; postoperative delirium; total intravenous anesthesia
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Objective: Investigate the effect of volatile anesthesia versus total intravenous anesthesia on the incidence of postoperative delirium and length of stay in patients undergoing transcatheter aortic valve replacement under general anesthesia. Design: Retrospective study. Setting: Single institution, academic medical center. Participants: Adult patients who underwent transcatheter aortic valve replacement under general anesthesia between November 2014 and February 2017. Interventions: This study was not an interventional study. Measurements and Main Results: Electronic medical records were reviewed for intraoperative maintenance anesthetic technique, hospital and intensive care unit length of stay, 30-day mortality, and documentation of delirium. Delirium was defined as either 1) positive Confusion Assessment Method for the Intensive Care Unit score or 2) documentation of delirium or confusion by the care team within 2 days of surgery. Overall, 116 patients were included and 84 (72%) received a total intravenous anesthesia technique. Twenty-three patients (20%) had postoperative delirium. The odds of delirium were lower in patients undergoing transcatheter aortic valve replacement with total intravenous anesthesia, compared with volatile anesthesia, even after adjusting for procedure approach (odds ratio 0.22, 95% confidence interval 0.06, 0.79, p = 0.02). No significant difference in hospital or intensive care unit length of stay was seen after adjusting for procedural characteristics. Conclusions: While postoperative delirium is a complex and multifactorial problem, the type of general anesthetic maintenance may contribute to the incidence of postoperative delirium in patients undergoing transcatheter aortic valve replacement, and total intravenous anesthesia may be an attractive alternative to volatile-based general anesthesia maintenance. (C) 2017 Elsevier Inc. All rights reserved.
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