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Minerva Cardiology and Angiology 2021 June;69(3):358-69

DOI: 10.23736/S2724-5683.20.05211-1


lingua: Inglese

Procedural sedation and analgesia for percutaneous high-tech cardiac procedures

Alberto ZANGRILLO 1, 2, Federica MORSELLI 1, Gaetano LOMBARDI 1, Andrey YAVOROVSKIY 3, Valery LIKHVANTSEV 4, Luigi BERETTA 1, 2, Fabrizio MONACO 1, Giovanni LANDONI 1, 2

1 IRCCS San Raffaele Scientific Institute, Milan, Italy; 2 IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; 3 Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia; 4 V. Negovsky Reanimatology Research Institute, Moscow, Russia

The interest in percutaneous high-tech cardiac procedures has increased in recent years together with its safety and efficacy. In fragile patients, procedural sedation and analgesia are used to perform most of the procedures. General anesthesia remains the technique of choice during the team learning curve and might be required in selected patients or in emergent situations. Despite the high costs of percutaneous high-tech cardiac procedures, the decrease in length of hospital stays, rate of intensive care admission and complications, balance the increase in devices costs. In fragile patients who undergo percutaneous high tech cardiac procedures, the primary role of the anesthesiologist is to prevent the need for postprocedural intensive care unit and complications rate. Starting from the experience of a large university third level hospital we identified the eight most commonly performed contemporary percutaneous high tech cardiac procedures (ventricular tachycardia and atrial fibrillation ablation, protected percutaneous coronary intervention, transcatheter aortic valve implantation, MitraClip® (Abbott Laboratories; Abbott Park, IL, USA), percutaneous patent foramen ovale closure, left atrial appendage closure, and dysfunctional lead extraction), discuss the role of procedural sedation and analgesia in this setting, and explore future perspectives.

KEY WORDS: Anesthesia; Intensive Care Units; Anesthesia, cardiac procedures; Cardiac surgical procedures

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