Characterizing the Anesthetic Management of Patients Undergoing Transradial Cardiac and Cerebrovascular Interventions: A Single-Institution Study
Transradial approaches are shown to reduce mortality, morbidity, access-site complications, hospital stay and costs when compared to the transfemoral approach in multiple cardiac trials. Use of the antispasmotic cocktail for these interventions poses challenges for anesthetic management. Differing practices between fields may need to be consolidated. This study aims to characterize the safety profile of cardiac and neuroanesthetic management protocols for transradial interventions, hypothesizing that the cocktail is safe from an anesthetic perspective.
We performed a retrospective chart review of patients undergoing transradial diagnostic cardiac and cerebrovascular interventions. Data collected included age, sex, comorbidities, prior antihypertensive medications, dose of radial antispasmotic cocktail, sedation dose, and periprocedural blood pressure changes.
Within 25 cardiac patients the average total cardene dose was 643.75 mcg, given over 3.2 injections on average. For 15 cerebrovascular patients, the average cardene dose was 458 mcg over 0.8 injections on average. Eleven cardiac patients received an average of 160 mcg of nitroglycerin, while 11 cerebrovascular patients received an average of 200 mcg of nitroglycerin. Average periprocedural MAP drop from induction was 29.72 in cardiac patients and 26.60 in cerebrovascular patients.
Our data demonstrate that anesthetic management has a favorable safety profile for both our cardiac and cerebrovascular patients. The drop in MAP between the two cohorts demonstrates no appreciable difference on descriptive analysis. Initial data demonstrate that, on average, cardiac patients may be receiving higher doses of cardene and lower doses of nitroglycerin.
Further data may guide protocol consolidation.
Bieser, Steven; Das, Somnath; Velagapudi, Lohit; Patel, Heli; Weinberg, Joshua; Moss, Lisa; Davis, Marguerite; Ruggiero, Nicholas; Jabbour, Pascal; and Romo, Victor, "Characterizing the Anesthetic Management of Patients Undergoing Transradial Cardiac and Cerebrovascular Interventions: A Single-Institution Study" (2021). Phase 1. Paper 11.