A UCLA study found that keeping patients awake but sleepy during transcatheter aortic valve
UCLA scientists have found that conscious sedation — a type of anesthesia in which patients remain awake but are sleepy and pain-free — is a safe and viable option to general anesthesia for people undergoing a minimally invasive heart procedure called transcatheter aorticvalve replacement. The study, led by Richard Shemin, MD, Robert and Kelly Day Professor of Surgery and chief of cardiac surgery, found that patients who underwent conscious sedation had a similar rate of adverse events to those who underwent anesthesia. However, those who received conscious sedation had shorter stays in the intensive care unit and shorter hospital stays. The direct costs for their care were 28 percent lower, and almost all other medical costs were lower as well.
Aortic stenosis is a common disease, particularly among people 75 and older, in which one of the valves of the heart narrows and impedes blood flow to the body. Previously, treating aortic stenosis required open-heart surgery. In recent years, the use of transcatheter aortic-valve replacement, or TAVR, has made the repair safer. Physicians place a new valve in the heart via a catheter inserted through the patient’s leg, which results in less injury and an easier recovery than open-heart surgery.
The study was the first to detail the cost differences and outcomes between conscious sedation and general anesthesia during TAVR. Researchers analyzed records of 196 adult patients who underwent TAVR at Ronald Reagan UCLA Medical Center between August 2012 and June 2016. The researchers note that a large-scale, controlled and randomized study should be conducted to validate their findings. Based on the study, patients undergoing TAVR should receive conscious sedation instead of general anesthesia whenever possible.
“Improved Costs and Outcomes with Conscious Sedation vs General Anesthesia in TAVR Patients: Time to Wake Up?” PLOS ONE, April 5, 2017