Non-invasive Ventilation during Left Atrial Appendage Closure under Sedation: Preliminary Experience with the Janus Mask
Published: Ann Card Anaesth. 2019 Oct-Dec; 22(4): 400–406
Authors: Alberto Zangrillo, Patrizio Mazzone, Alessandro Oriani, Marina Pieri, Giovanna Frau, Giuseppe D’Angelo, Chiara Sartini, Riccardo Capucci, Alessandro Belletti, Paolo Della Bella, Fabrizio Monaco
This is a retrospective case-control study of the use of non-invasive ventilation during left atrial appendage occlusion (LAAO).
- During LAAO, transoesophageal echocardiography (TEE) is required in all patients to guide the transseptal puncture and to have a full view of the LAA.
- Percutaneous LAAO is frequently performed in old, frail patients with several comorbidities which increase the risks of complications of general anesthesia.
- The possibility of undergoing LAAO under procedural sedation is attractive.
- The authors compared 11 patients undergoing LAAO under sedation with assisted spontaneous ventilation using the Janus Mask, a device designed for endoscopic procedures, with 11 patients underwent LAAO received general anaesthesia.
- Patients in the Janus Mask group showed increased PaCO2 which led to a transient pH decrease 45 min after the beginning of the procedural sedation
- No differences in the intraoperative haemodynamic parameters, oxygenation and discharge criteria were noted.
- Surgeons and anaesthesiologists showed comparable satisfaction with both techniques of anaesthesia.
- Three cases in the Janus mask group developed transient intraoperative apnoea which were treated with reduction of sedation without further apparent complications.
- This preliminary study demonstrated the feasibility and safety of the procedural sedation with assisted spontaneous ventilation using the Janus Mask as an alternative to general anaesthesia during the LAAO procedures.
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