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The Importance of Conscious Sedation for Life-Saving Valve Procedures in Patients With Rheumatic Heart Disease From Low- to Middle-Income Countries

Authors:

Marta Eugenia Alcici,

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Lucas Lodi-Junqueira,

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Guilherme Rafael Sant’Anna,

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Juliana Rodrigues Soares,

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Diogo Antônio Gomes Tiago,

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Priscila Lima Tavares,

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Gabriel Prado Saad,

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Igor Ferreira de Sales,

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Emmy Okello,

Uganda Heart Institute, Mulago Hospital Complex, Kampala, UG
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Joselyn Rwebembera,

Uganda Heart Institute, Mulago Hospital Complex, Kampala, UG
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William A.M. Esteves,

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Maria Carmo P. Nunes

Hospital das Clínicas, School of Medicine, Hospital das Clinicas of the Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Abstract

Background: Severe valve disease, which requires intervention, remains strongly associated with mortality in patients with rheumatic heart disease. Percutaneous mitral commissurotomy (PMC) is the procedure of choice for the treatment of patients with isolated or predominantly rheumatic mitral stenosis. This procedure has been performed under sedation to avoid the potential effects of general anesthesia on intracardiac pressure measurements. However, there are limited data on sedation during PMC, especially using easily available medications in low- and middle-income countries.

Objectives: This study was designed to evaluate the efficacy and hemodynamic effects of conscious sedation during PMC in patients with significant mitral stenosis.

Methods: This study prospectively enrolled 23 patients who underwent PMC with the Inoue balloon technique for hemodynamically significant mitral stenosis. For conscious sedation, midazolam 25 mg/kg and fentanyl 1 mg/kg were administered, and 5 min after the infusion, the level of sedation was evaluated by Ramsay sedation scale. A range of invasive hemodynamic measurements, including cardiac output and pulmonary artery pressures, were recorded before and immediately after sedation.

Results: The mean age was 44.9 ± 10.8 years, and 19 patients (83%) were women. After sedation, the majority of patients were in categories 2 and 3 of the Ramsay sedation scale (cooperative, orientated, tranquil, and responding to commands). Oxygen saturation dropped from an average of 98.5% to 96.0% without supplementary oxygen. Left ventricular systolic pressure and central aortic pressures decreased after sedation. However, none of the other parameters changed significantly after sedation, including pulmonary artery pressures, pulmonary vascular resistance, and cardiac index.

Conclusions: This simple model of conscious sedation was able to promote anxiolysis, analgesia, and comfort for the procedure without serious hemodynamic effects, which can be a reasonable choice in developing countries.

Highlights

  • Percutaneous valve intervention is the main treatment for severe rheumatic MS.
  • Effective interventions with affordable cost are essential to manage valve disease in developing countries.
  • Conscious sedation using easily available medication promotes comfort without hemodynamic effects.
How to Cite: Alcici ME, Lodi-Junqueira L, Sant’Anna GR, Soares JR, Gomes Tiago DA, Tavares PL, et al.. The Importance of Conscious Sedation for Life-Saving Valve Procedures in Patients With Rheumatic Heart Disease From Low- to Middle-Income Countries. Global Heart. 2019;14(3):311–6. DOI: http://doi.org/10.1016/j.gheart.2019.07.003
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Published on 01 Sep 2019.
Peer Reviewed

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