Vivian Ip1, Blaine Achen2, Jeevan Nagendran3. 1. Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada. hip@ualberta.ca. 2. Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada. 3. Department of Cardiothoracic Surgery, Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
Abstract
PURPOSE: Transcatheter aortic valve implantation (TAVI) has become a widely used technique for treating aortic stenosis. Subclavian access may be warranted in the presence of poor vasculature that precludes femoral access. Conscious sedation is increasingly being adopted with some evidence suggesting better outcomes compared with those of general anesthesia. We describe the use of two regional anesthetic techniques to facilitate subclavian access for TAVI. CLINICAL FEATURES: Our case report involves the successful management of a challenging patient with severe peripheral vasculopathy and respiratory compromise undergoing a trans-subclavian TAVI. Surgical anesthesia was provided by low-dose local anesthetic titrated via an interscalene perineural catheter and a single-shot superficial cervical plexus block while preserving respiratory function. CONCLUSIONS: The interscalene catheter in situ allowed for low-dose local anesthetic titration without further jeopardizing the pulmonary function throughout the procedure. Unlike other interfascial plane blocks, combined low-dose superficial cervical plexus and interscalene brachial plexus blocks offer surgical anesthesia and limb immobility, thus providing optimal condition for subclavian TAVI to be performed with minimal sedation.
PURPOSE: Transcatheter aortic valve implantation (TAVI) has become a widely used technique for treating aortic stenosis. Subclavian access may be warranted in the presence of poor vasculature that precludes femoral access. Conscious sedation is increasingly being adopted with some evidence suggesting better outcomes compared with those of general anesthesia. We describe the use of two regional anesthetic techniques to facilitate subclavian access for TAVI. CLINICAL FEATURES: Our case report involves the successful management of a challenging patient with severe peripheral vasculopathy and respiratory compromise undergoing a trans-subclavian TAVI. Surgical anesthesia was provided by low-dose local anesthetic titrated via an interscalene perineural catheter and a single-shot superficial cervical plexus block while preserving respiratory function. CONCLUSIONS: The interscalene catheter in situ allowed for low-dose local anesthetic titration without further jeopardizing the pulmonary function throughout the procedure. Unlike other interfascial plane blocks, combined low-dose superficial cervical plexus and interscalene brachial plexus blocks offer surgical anesthesia and limb immobility, thus providing optimal condition for subclavian TAVI to be performed with minimal sedation.