Intraoperative Corticosteroids and Pacemaker Implantation After Transcatheter Aortic Valve Replacement.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. However, conduction disturbances leading to pacemaker implantation remain a common complication, increasing morbidity and mortality in these patients. Hence, measures to lower its incidence should be taken, and corticosteroid therapy could be effective by reducing inflammation caused by direct mechanical trauma to the conduction system. METHODS: A retrospective cohort study was conducted at the Centro Hospitalar de Vila Nova de Gaia/Espinho, analyzing the medical records of patients with native severe aortic stenosis who underwent transfemoral TAVR in 2022. The Chi-square test was used to compare the rate of pacemaker implantation in patients who received corticosteroids with patients who didn't. The statistical significance was considered for a p-value <0.05. RESULTS: A total of 341 patients were included in this study. Monitored anesthesia care was the preferred anesthetic technique (99.1%). Sixty-three point three percent (63.3%) of patients received corticosteroids at the beginning of the procedure. Corticosteroid administration did not significantly affect the incidence of permanent pacemaker implantation (p=0.277), vascular complications on the access site (p=0.765), or in-hospital mortality (p=0.909). Male gender, 1st-degree atrioventricular block, and right branch block were the only identified predictors of permanent pacemaker implantation after transfemoral TAVR (p=0.041 <0.001 and <0.001, respectively). CONCLUSION: Corticosteroid administration at the beginning of TAVR doesn't seem to influence the incidence of permanent pacemaker implantation, which can suggest that other factors play a more important role in the development of conduction disturbances leading to pacemaker implantation.

Anesthetic management of a patient with acquired angioedema submitted to broncofibroscopy: a case report.

Acquired angioedema with C1 inhibitor deficiency (AAE-C1INH) is a very rare condition of bradykinin-mediated angioedema. One of its major complications is potentially life-threatening, laryngeal edema. We report a 53-year-old woman with AAE-C1INH proposed for an elective broncofibroscopy. The direct stimulation caused by broncofibroscopy poses a high risk of angioedema, thus presenting an anesthetic challenge. Due to the risk of death, it is essential to adopt preventive measures. Short-term prophylaxis was performed, and the acute treatment was readily available. A well-structured multidisciplinary periprocedural plan makes it possible to safely approach the airway, in a remote area of the hospital.

Anesthetic management of a patient with acquired angioedema submitted to broncofibroscopy: a case report

Abstract Acquired angioedema with C1 inhibitor deficiency (AAE-C1INH) is a very rare condition of bradykinin-mediated angioedema. One of its major complications is potentially life-threatening, laryngeal edema. We report a 53-year-old woman with AAE-C1INH proposed for an elective broncofibroscopy. The direct stimulation caused by broncofibroscopy poses a high risk of angioedema, thus presenting an anesthetic challenge. Due to the risk of death, it is essential to adopt preventive measures. Short-term prophylaxis was performed, and the acute treatment was readily available. A well-structured multidisciplinary periprocedural plan makes it possible to safely approach the airway, in a remote area of the hospital.

Abnormal motor blockade after epidural analgesia caused by pneumorrhachis and the role of hyperbaric oxygen treatment: a case report.

INTRODUCTION: Pneumorrhachis is a rare clinical entity that is usually asymptomatic. Previous reports have associated such events with epidural insertion using a loss of resistance (LOR) to air technique. This report describes a case of symptomatic epidural pneumorrhachis following epidural anaesthesia using LOR to saline. CASE REPORT: A 32-year-old American Society of Anesthesiologists (ASA) Classification II female patient was admitted for unplanned caesarean section. Epidural anaesthesia was performed at the L3-4 space using LOR to saline. The procedure, including delivery of the neonate, was uneventful. In the recovery room, a local anaesthetic infusion via an elastomeric pump (infusion 'balloon') was started. Two hours after initiation of the infusion the patient complained of motor blockade, so it was stopped. Two hours later she remained paraparetic, and a neurologist assessment was required. A computed tomography scan showed epidural pneumorrhachis at the L2-3 level. The patient was referred for emergent hyperbaric oxygen treatment (US Navy Treatment Table 5) and following one session the patient recovered completely. DISCUSSION: Anaesthetists should be aware of this rare complication, which is easily overlooked. Hyperbaric oxygen treatment is a first line treatment for gas-associated lesions with neurological impairment. Timely referral is essential to prevent irreversible deficits.

Measuring otoplasty outcome: Expanding the validity to caregivers' perspective and to Portuguese-speaking children.

OBJECTIVE: The GBI (Glasgow Benefit Inventory) and the GCBI (Glasgow Children's Benefit Inventory) are used to evaluate patient-reported Health-Related Quality of Life (HRQoL) following otoplasty for prominent ears. The aim of this study was to validate them through patients' and caregivers' perspectives and in Portuguese language versions. STUDY DESIGN: After translation to Portuguese, the GBI and the GCBI were applied to patients (n = 255) who underwent otoplasty throughout a five-year span and to their caregivers, respectively. A second set of questionnaires (retest) was applied to assess reliability. Caregivers were subsequently contacted to evaluate aesthetic satisfaction, recommendation to others, postoperative complications and main motivation for surgery. SETTING: Paediatric Surgery Department of a tertiary hospital in Porto, Portugal. PARTICIPANTS: 134 patients (aged 10.9 ± 3.6 years, 61.2% males) and their caregivers (52.5% responders). MAIN OUTCOME MEASURES: Impact on HRQoL using the Portuguese GBI and GCBI (global score, -100 to 100). Validity assessed by principal component factor analysis, Cronbach's α and Intraclass Correlation Coefficient (ICC). RESULTS: The GBI was 30.1 ± 25.7 and the GCBI was 22.6 ± 23.0. For the GBI, three subscales were identified, explaining 63.3% of variance. For the GCBI, two subscales were identified, accounting for 66.8% of variance. Both the GBI and the GCBI showed a high internal consistency (α = 0.92 and 0.94, respectively). 79% were satisfied and 92% recommended the surgery. Statistically significant higher scores were found in satisfied patients, in those who underwent surgery due to teasing, and in females. CONCLUSIONS: The Portuguese GBI and GCBI proved to be valid and reliable to evaluate HRQoL following otoplasty in Portuguese-speaking children. The outcome was very favourable; almost all patients would recommend the surgery.