• Nigro NetoCaetanoCInstituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil. Electronic address: caenigro@uol.com.br., Emerson Domingos da Costa, Francisco José Lucena Bezerra, Mariana Suete Guimarães Ruy, Jose Leonardo Izquierdo Saurith, and João Henrique Zucco Viesi.
• Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil. Electronic address: caenigro@uol.com.br.
• Braz J Anesthesiol. 2018 Sep 1; 68 (5): 437-441.

Background And ObjectivesAortic stenosis is the most common type of heart valve disease. Percutaneous aortic valve replacement has become the alternative for patients considered at high risk for surgery. Controlled mechanical ventilation with tracheal intubation has been the choice for this type of procedure, however the use of noninvasive ventilation in cardiac patients has shown to be beneficial. Janus is a novel full-face mask that allows application of noninvasive ventilation support during anesthesia. Our main objective was to evaluate the feasibility of transcatheter aortic valve replacement with prolonged transesophageal echocardiographic monitoring under deep inhalational sedation delivered through a new mask for noninvasive ventilation.MethodsA case series observational study that included five patients with critical aortic stenosis that underwent inhalational anesthesia with sevoflurane for transcatheter aortic valve replacement in a hybrid room of a teaching hospital. Standard monitors and bispectral index were used, followed by inhalational induction and placement of the Janus mask. Anesthesia was maintained with sevoflurane. Patients were transferred to intensive care unit after the procedure. Complications related to the mask use, transesofageal echocardiography accessibility and respiratory implications to the patients were recorded.ResultsAll procedures were uneventful and no major complications were observed intraoperatively. One patient presented CO2 retention (50mmHg) and sevoflurane leak around the central opening of the mask, both without clinical significance.ConclusionsThe use of inhalational anesthesia with the facial mask Janus is a safe and efficient alternative to general anesthesia with tracheal intubation for transcatheter aortic valve replacement and can easily accommodate the use of transesophageal echocardiography intraoperatively.Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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