Key result
Midazolam and fentanyl during PMC achieve target sedation with stable hemodynamics and a ~2.5% oxygen drop.
Why the study?
Data are limited on sedation during percutaneous mitral commissurotomy, particularly using easily available medications in low- and middle-income countries.
Does conscious sedation with midazolam and fentanyl provide effective sedation without adverse hemodynamic effects in patients with significant mitral stenosis undergoing percutaneous mitral commissurotomy?
Observational (n=23)
Does conscious sedation with midazolam and fentanyl provide effective sedation without adverse hemodynamic effects in patients with significant mitral stenosis undergoing percutaneous mitral commissurotomy?
Conscious sedation with midazolam and fentanyl provides effective anxiolysis and analgesia without serious adverse hemodynamic effects during percutaneous mitral commissurotomy.
Answers are grounded in this paper and cite their sources.
May support conscious sedation in PMC; leaves open randomized confirmation of safety.
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 μg/kg and fentanyl 1 μg/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.
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Alcici et al. (2019) conducted an observational in Hemodynamically significant mitral stenosis (n=23). Conscious sedation (midazolam and fentanyl) was evaluated on Efficacy (Ramsay sedation scale) and hemodynamic effects before and immediately after sedation. Conscious sedation with midazolam and fentanyl during percutaneous mitral commissurotomy achieved target sedation with a mild drop in oxygen saturation (98.5% to 96.0%) and stable hemodynamics.
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