• Leonard Pitts, Nicolas Hellner, Markus Kofler, Martin Ryschka, Axel Unbehaun, Benjamin O'Brien, Jörg Kempfert, and Matthias Hommel.
• Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. Electronic address: leonard.pitts@dhzc-charite.de.
• J. Cardiothorac. Vasc. Anesth. 2024 Jun 1; 38 (6): 135313601353-1360.

ObjectivesTo investigate the effect of an audiovisual distraction system on the dose of remifentanil for perioperative sedation during transcatheter aortic valve implantation under monitored anesthesia care.DesignSingle-center prospective randomized nonblinded study.SettingTertiary referral academic hospital.ParticipantsNinety patients who underwent transfemoral transcatheter aortic valve implantation between July 2019 and July 2021.InterventionsPatients were randomized to use either a novel audiovisual distraction system during the intervention (n = 45) or standard care without an audiovisual distraction system (n = 45).Measurements And Main ResultsStandardized questionnaires were given to each patient at admission and before and after the intervention to assess their levels of anxiety. Primary endpoints were the average and peak infusion rates of remifentanil. All patients were considered for the final analysis according to an intention-to-treat design. No relevant differences in pre- and postinterventional anxiety status were observed between the groups. Similarly, there were no significant differences in reported pain scores (p = 0.364). The average infusion rate (p = 0.028) and peak infusion rate (p = 0.025) of remifentanil were lower in the group with an audiovisual distraction system.ConclusionsAudiovisual distraction is a useful adjunct to reduce the dose of remifentanil under monitored anesthesia care during transcatheter aortic valve implantation. Larger studies are needed to evaluate potential positive effects on patient satisfaction, incidence of delirium, and possible economic benefits.Copyright © 2023 Elsevier Inc. All rights reserved.

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