成人心脏介入术中的麻醉管理
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摘要
心脏介入术属于有创治疗,患者在术中会经历不同程度的疼痛与不适。一些新型介入治疗技术的创伤更大,成人患者需要接受深度镇静或全身麻醉,才能顺利完成介入治疗。目前,国内尚无成人心脏介入术中麻醉管理的相关指南或专家共识。本文通过文献回顾和临床经验总结,归纳成人心脏介入术中麻醉管理的特点。
Cardiac interventional therapy is an invasive treatment. Patients will experience different degrees of pain and discomfort during the procedure. Some new interventional techniques are more traumatic, so adult patients need deep sedation or general anesthesia to successfully complete interventional therapy. At present, there are no guidelines or expert consensus on anesthesia management in adult cardiac interventions in China. This article summarizes the characteristics of anesthesia management in adult cardiac interventions through literature review and clinical experience.
Cardiac interventional therapy is an invasive treatment. Patients will experience different degrees of pain and discomfort during the procedure. Some new interventional techniques are more traumatic, so adult patients need deep sedation or general anesthesia to successfully complete interventional therapy. At present, there are no guidelines or expert consensus on anesthesia management in adult cardiac interventions in China. This article summarizes the characteristics of anesthesia management in adult cardiac interventions through literature review and clinical experience.
引文
[1] Drager LF, Mcevoy RD, Barbe F, et al. Sleep Apnea and Cardiovascular Disease:Lessons From Recent Trials and Need for Team Science. Circulation. 2017,136(19):1840-1850.
[2] Fajadet J, Capodanno D, Stone G W. Management of left main disease:an update. European Heart Journal, 2018.
[3] Tajti P, Burke MN, Karmpaliotis D, et al. Update in the Percutaneous Management of Coronary Chronic Total Occlusions. JACC Cardiovasc Interv. 2018,11(7):615-625.
[4] Espiritu D, Onohara D, Kalra K, et al. Transcatheter Mitral Valve Repair Therapies:Evolution, Status and Challenges. Ann Biomed Eng, 2017,45(2):332-359.
[5] American Society of Anesthesiologists, 2009:Continuum of depth of sedation:definition of general anesthesia and levels of sedation/analgesia. Available at:http://www.asahq.org/For-HealthcareProfessionals/Standards-Guidelines-and-Statements.aspx.(Accessed February 11,2013).
[6] Hession P M, Joshi G P. Sedation:Not Quite That Simple[J].Anesthesiol Clin. 2010,28(2):281-294
[7] Bellolio M F, Gilani W I, Barrionuevo P, et al. Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department:A Systematic Review and Meta. analysis. Acad Emerg Med. 2016,23(2):119-134.
[8] Standards for Basic Anesthetic Monitoring. Committee of Origin:Standards and Practice Parameters(Approved by the ASA House of Delegates on October 21,1986, last amended on October 20,2010, and last affirmed on October 28,2016)
[9] Frank SM, Beattie C, Christopherson R, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia.The Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology. 1993, 78(3):468-476.
[10] Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997,277:1127-1134.
[11] Leslie K, Sessler DI. Perioperative hypothermia in the high-risk surgical patient. Best Pract Res Clin Anaesthesiol. 2003,17:485-498.
[12] Kim SH, Lilot M, Sidhu KS, et al. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure:a systematic review and meta-analysis.Anesthesiology. 2014,120(5):1080-1097.
[13]Pathan F, Hecht H, Narula J, et al. Roles of Transesophageal Echocardiography and Cardiac Computed Tomography for Evaluation of Left Atrial Thrombus and Associated Pathology:A Review and Critical Analysis. JACC Cardiovasc Imaging. 2018,11(4):616-627
[14] Nakagawa H, Jackman WM. Electroporation(revival of directcurrent ablation):new approach for increasing epicardial ablation safety in close proximity to a coronary artery. Circ Arrhythm Electrophysiol. 2014,7:779-780.
[15] Bhatt HV, Syros G, Greco M, et al. Ablation therapy for atrial fibrillation:Implications for the anesthesiologist. J Cardiothorac Vase Anesth. 2015,29:1341-1356.
[16] Nicoara A, Holmquist F, Raggains C, et al. Anesthesia for catheter ablation procedures. J Cardiothorac Vase Anesth. 2014,28:1589-1603.
[17] Reddy K, Jaggar S, Gillbe C. The anaesthetist and the cardiac catheterisation laboratory. Anaesthesia. 2006,61:1175-1186.
[18] Shook DC, Gross W. Offsite anesthesiology in the cardiac catheterization lab. Curr Opin Anaesthesiol. 2007,20:352-358.
[19] Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002, 346:877-883.
[20] Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities:a report of the American college of cardiology/American heart association task force on practice guidelines(writing committee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices)developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008, 51:el-e62.
[21] Weiss R, Knight BP, Gold MR, et al. Safety and efficacy of a totally subcutaneous implantable-cardioverter defibrillator. Circulation.2013,128:944-953.
[22] Mahlow WJ, Craft RM, Misulia NL, et al. A perioperative management algorithm for cardiac rhythm management devices:the PACED-OP protocol. Pacing Clin Electrophysiol. 2013,36:238-248.
[23] Marquie C, Duchemin A, Klug D, et al. Can we implant cardioverter defibrillator under minimal sedation? Europace. 2007,9:545-550.
[24] Kremers MS, Hammill SC, Berul CI, et al. The National ICD Registry Report:version 2.1 including leads and pediatrics for years2010 and 2011. Heart Rhythm. 2013,10(4):e59-e65.
[25] Kiat Ang C,Leung DY, Lo S,et al. Effect of local anesthesia and intravenous sedation on pain perception and vasovagal reactions during femoral arterial sheath removal after percutaneous coronary intervention. Int J Cardiol. 2007,116(3):321-326.
[26] Deftereos S, Giannopoulos G, Raisakis K, et al. Moderate Procedural Sedation and Opioid Analgesia During Transradial Coronary Interventions to Prevent Spasm:A Prospective Randomized Study.JACC Cardiovasc Interv. 2013,6(3):267-273.
[27] Wagenaar T C, Rohling W J, Klomp M, et al. Sedative treatment regimes in all Dutch centers carrying out percutaneous coronary interventions, a comprehensive nationwide survey. European Journal of CardiovascularNursing Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. 2010,9(3):195-198.
[28] Rios SA, Bravo CA, Weinreich M, et al. Meta-Analysis and Trial Sequential Analysis Comparing Percutaneous Ventricular Assist Devices Versus Intra-Aortic Balloon Pump During High-Risk Percutaneous Coronary Intervention or Cardiogenic Shock. Am J Cardiol. 2018,0002-9149.
[29] Maas EH, Pieters BM, Van de Velde M, et al. General or Local Anesthesia for TAVI? A Systematic Review of the Literature and Meta-Analysis. Curr Pharm Des. 2016,22(13):1868-1878.
[30] De BC,Mastrokostopoulos A, Philippart R, et al. What are the remaininglimitations of TAVI? J Cardiovasc Surg. 2018,59(3):378-380.
[31] Waugh JB, Epps CA, Khodneva YA. Capnography enhances surveillance of respiratory events during procedural sedation:a meta-analysis. J Clin Anesth. 2011; 23:189-96.
[32] Moss RR, Ivens E, Pasupati S, Humphries K, Thompson CR, Munt B,Sinhal A, Webb JG. Role of echocardiography in percutaneous aortic valve implantation. JACC Cardiovasc Imaging 2008;1:15-24.
[33]Auffret V, Boulmier D, Oger E, Bedossa M, Donal E, Laurent M, Sost G, Beneux X, Harmouche M, Verhoye JP, Le Breton H.Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation. Arch Cardiovasc Dis 2014;107:10-20.
[2] Fajadet J, Capodanno D, Stone G W. Management of left main disease:an update. European Heart Journal, 2018.
[3] Tajti P, Burke MN, Karmpaliotis D, et al. Update in the Percutaneous Management of Coronary Chronic Total Occlusions. JACC Cardiovasc Interv. 2018,11(7):615-625.
[4] Espiritu D, Onohara D, Kalra K, et al. Transcatheter Mitral Valve Repair Therapies:Evolution, Status and Challenges. Ann Biomed Eng, 2017,45(2):332-359.
[5] American Society of Anesthesiologists, 2009:Continuum of depth of sedation:definition of general anesthesia and levels of sedation/analgesia. Available at:http://www.asahq.org/For-HealthcareProfessionals/Standards-Guidelines-and-Statements.aspx.(Accessed February 11,2013).
[6] Hession P M, Joshi G P. Sedation:Not Quite That Simple[J].Anesthesiol Clin. 2010,28(2):281-294
[7] Bellolio M F, Gilani W I, Barrionuevo P, et al. Incidence of Adverse Events in Adults Undergoing Procedural Sedation in the Emergency Department:A Systematic Review and Meta. analysis. Acad Emerg Med. 2016,23(2):119-134.
[8] Standards for Basic Anesthetic Monitoring. Committee of Origin:Standards and Practice Parameters(Approved by the ASA House of Delegates on October 21,1986, last amended on October 20,2010, and last affirmed on October 28,2016)
[9] Frank SM, Beattie C, Christopherson R, et al. Unintentional hypothermia is associated with postoperative myocardial ischemia.The Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology. 1993, 78(3):468-476.
[10] Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997,277:1127-1134.
[11] Leslie K, Sessler DI. Perioperative hypothermia in the high-risk surgical patient. Best Pract Res Clin Anaesthesiol. 2003,17:485-498.
[12] Kim SH, Lilot M, Sidhu KS, et al. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure:a systematic review and meta-analysis.Anesthesiology. 2014,120(5):1080-1097.
[13]Pathan F, Hecht H, Narula J, et al. Roles of Transesophageal Echocardiography and Cardiac Computed Tomography for Evaluation of Left Atrial Thrombus and Associated Pathology:A Review and Critical Analysis. JACC Cardiovasc Imaging. 2018,11(4):616-627
[14] Nakagawa H, Jackman WM. Electroporation(revival of directcurrent ablation):new approach for increasing epicardial ablation safety in close proximity to a coronary artery. Circ Arrhythm Electrophysiol. 2014,7:779-780.
[15] Bhatt HV, Syros G, Greco M, et al. Ablation therapy for atrial fibrillation:Implications for the anesthesiologist. J Cardiothorac Vase Anesth. 2015,29:1341-1356.
[16] Nicoara A, Holmquist F, Raggains C, et al. Anesthesia for catheter ablation procedures. J Cardiothorac Vase Anesth. 2014,28:1589-1603.
[17] Reddy K, Jaggar S, Gillbe C. The anaesthetist and the cardiac catheterisation laboratory. Anaesthesia. 2006,61:1175-1186.
[18] Shook DC, Gross W. Offsite anesthesiology in the cardiac catheterization lab. Curr Opin Anaesthesiol. 2007,20:352-358.
[19] Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002, 346:877-883.
[20] Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities:a report of the American college of cardiology/American heart association task force on practice guidelines(writing committee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices)developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008, 51:el-e62.
[21] Weiss R, Knight BP, Gold MR, et al. Safety and efficacy of a totally subcutaneous implantable-cardioverter defibrillator. Circulation.2013,128:944-953.
[22] Mahlow WJ, Craft RM, Misulia NL, et al. A perioperative management algorithm for cardiac rhythm management devices:the PACED-OP protocol. Pacing Clin Electrophysiol. 2013,36:238-248.
[23] Marquie C, Duchemin A, Klug D, et al. Can we implant cardioverter defibrillator under minimal sedation? Europace. 2007,9:545-550.
[24] Kremers MS, Hammill SC, Berul CI, et al. The National ICD Registry Report:version 2.1 including leads and pediatrics for years2010 and 2011. Heart Rhythm. 2013,10(4):e59-e65.
[25] Kiat Ang C,Leung DY, Lo S,et al. Effect of local anesthesia and intravenous sedation on pain perception and vasovagal reactions during femoral arterial sheath removal after percutaneous coronary intervention. Int J Cardiol. 2007,116(3):321-326.
[26] Deftereos S, Giannopoulos G, Raisakis K, et al. Moderate Procedural Sedation and Opioid Analgesia During Transradial Coronary Interventions to Prevent Spasm:A Prospective Randomized Study.JACC Cardiovasc Interv. 2013,6(3):267-273.
[27] Wagenaar T C, Rohling W J, Klomp M, et al. Sedative treatment regimes in all Dutch centers carrying out percutaneous coronary interventions, a comprehensive nationwide survey. European Journal of CardiovascularNursing Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. 2010,9(3):195-198.
[28] Rios SA, Bravo CA, Weinreich M, et al. Meta-Analysis and Trial Sequential Analysis Comparing Percutaneous Ventricular Assist Devices Versus Intra-Aortic Balloon Pump During High-Risk Percutaneous Coronary Intervention or Cardiogenic Shock. Am J Cardiol. 2018,0002-9149.
[29] Maas EH, Pieters BM, Van de Velde M, et al. General or Local Anesthesia for TAVI? A Systematic Review of the Literature and Meta-Analysis. Curr Pharm Des. 2016,22(13):1868-1878.
[30] De BC,Mastrokostopoulos A, Philippart R, et al. What are the remaininglimitations of TAVI? J Cardiovasc Surg. 2018,59(3):378-380.
[31] Waugh JB, Epps CA, Khodneva YA. Capnography enhances surveillance of respiratory events during procedural sedation:a meta-analysis. J Clin Anesth. 2011; 23:189-96.
[32] Moss RR, Ivens E, Pasupati S, Humphries K, Thompson CR, Munt B,Sinhal A, Webb JG. Role of echocardiography in percutaneous aortic valve implantation. JACC Cardiovasc Imaging 2008;1:15-24.
[33]Auffret V, Boulmier D, Oger E, Bedossa M, Donal E, Laurent M, Sost G, Beneux X, Harmouche M, Verhoye JP, Le Breton H.Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation. Arch Cardiovasc Dis 2014;107:10-20.