Anestesia general vs. sedación: desenlaces de falla renal, delirium y estancia en la unidad de cuidados intensivos después del implante valvular aórtico transcatéter. Estudio de cohorte retrospectivo monocéntrico (Fundación Cardiovascular de Colombia, periodo 2010-2019)

Blanco Ramírez, Milton Leonardo

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dc.contributor	Villar, Luis Ángel
dc.contributor	Pacheco Leal, Luz Jenny
dc.contributor	Rincón, José Domingo
dc.contributor	Pacheco Leal, Luz Jenny [0001135430]
dc.creator	Blanco Ramírez, Milton Leonardo
dc.date	2021-08-12T21:44:48Z
dc.date	2021-08-12T21:44:48Z
dc.date	2021-05
dc.date.accessioned	2022-03-14T20:20:27Z
dc.date.available	2022-03-14T20:20:27Z
dc.identifier	http://hdl.handle.net/20.500.12749/13804
dc.identifier	instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier	reponame:Repositorio Institucional UNAB
dc.identifier	repourl:https://repository.unab.edu.co
dc.identifier.uri	http://biblioteca-repositorio.clacso.edu.ar/handle/CLACSO/22428
dc.description	El implante valvular aórtico transcatéter (TAVI) percutáneo surge como opción terapéutica para los pacientes con estenosis aortica sintomática con riesgo quirúrgico alto o inoperable. Se puede realizar bajo anestesia general (AG) o bajo anestesia con sedación (AS). Objetivo: Evaluar el impacto del tipo de anestesia y desenlaces principales en pacientes sometidos a TAVI. Métodos: Con un diseño de cohorte retrospectiva se evaluaron todas las TAVI percutáneas de la Fundación Cardiovascular de Colombia (FCV) 2010 - 2019. Se realizó un análisis con medidas de tendencia central, bivariado con variables relevantes y se busco asociación con los principales desenlaces por medio de una regresión logística. Resultados: Se incluyeron 98 pacientes (Hombres 57(57,1%), edad promedio 77 años de los cuales 44 (44.9%) recibieron anestesia con sedación y 54 (55.1%) se operaron con anestesia general; comorbilidades más frecuentes: hipertensión arterial (75.5%), infarto de miocardio (51.0%), EUROSCORE promedio de 11.6 (Desviación Estándar (DE) 10.19). La tasa de conversión a anestesia general fue de 5 (11.4%). Los desenlaces principales fueron delirium postoperatorio de 9.1% (6.8% en AS vs. 11.1% en AG, p=0.464) y estancia prolongada en unidad de cuidados intensivos (UCI) (34.1% en AS vs. 48.1% en AG, p=0.161); no hubo número suficiente de eventos de falla renal posoperatoria. Mortalidad a 30 días de 9.1% (6.8% en AS vs. 11.1% en AG, p=0.464). Basado en los resultados de esta cohorte no existe evidencia de asociación entre el tipo de anestesia y los desenlaces del estudio. Conclusiones: No se encontró asociación entre la incidencia de delirium postoperatorio, la estancia en unidad de cuidados intensivos y el tipo de anestesia, aunque se evidencia una tendencia protectora en quienes reciben anestesia con sedación. No se logró evaluar el desenlace falla renal y de mortalidad por un número insuficiente de eventos en la cohorte.
dc.description	1. Anestesia general vs. sedación: desenlaces de falla renal, delirium, y estancia en la unidad de cuidados intensivos después del implante valvular aórtico transcatéter. Estudio de cohorte retrospectivo monocéntrico (Fundación Cardiovascular de Colombia, periodo 2010-2019) ................................................... 8 2. Resumen del proyecto....................................................................................... 8 3. Project summary ............................................................................................... 8 4. Descripción del proyecto ................................................................................... 9 5. Marco teórico ................................................................................................... 10 6. Estado del arte ................................................................................................ 16 7. Objetivo general y objetivos secundarios ........................................................ 18 8. Metodología propuesta .................................................................................... 19 9. Resultados/productos esperados y potenciales beneficiarios ......................... 27 9.1 Productos resultados de actividades de generación de nuevo conocimiento:...................................................................................................... 27 9.2 Productos resultados de actividades de desarrollo tecnológico e innovación: ......................................................................................................... 28 9.3 Conducentes al fortalecimiento de la capacidad científica institucional: .. 28 9.4 Productos resultados de actividades de apropiación social del conocimiento:...................................................................................................... 28 10. Impactos esperados a partir del uso de los resultados: .............................. 28 11. Disposiciones vigentes ................................................................................ 28 12. Cronograma de actividades ........................................................................ 29 13. Resultados .................................................................................................. 31 14. Discusión ..................................................................................................... 37 15. Conclusiones ............................................................................................... 40 16. Referencias ................................................................................................. 41 17. Anexos ........................................................................................................ 44 17.1 Anexo 1: Carta de Autorización Comité de Ética de la Fundación Cardiovascular de Colombia. .............................................................................. 44 17.2 Anexo 2: Artículo preliminar ....................................................45
dc.description	Maestría
dc.description	The percutaneous transcatheter aortic valve implant (TAVI) emerges as a therapeutic option for patients with symptomatic aortic stenosis with high or inoperable surgical risk. It can be performed under general anesthesia (AG) or under anesthesia with sedation (AS). Objective: To evaluate the impact of the type of anesthesia and main outcomes in patients undergoing TAVI. Methods: With a retrospective cohort design, all percutaneous TAVIs from the Fundación Cardiovascular de Colombia (FCV) 2010 - 2019 were evaluated. An analysis was performed with measures of central tendency, bivariate with relevant variables, and an association was sought with the main outcomes by means of a logistic regression. Results: 98 patients were included (Men 57 (57.1%), mean age 77 years of which 44 (44.9%) received anesthesia with sedation and 54 (55.1%) underwent general anesthesia; most frequent comorbidities: arterial hypertension (75.5%), myocardial infarction (51.0%), mean EUROSCORE of 11.6 (Standard Deviation (SD) 10.19). The conversion rate to general anesthesia was 5 (11.4%). The main outcomes were 9.1% postoperative delirium (6.8% in AS vs. 11.1% in AG, p = 0.464) and prolonged stay in the intensive care unit (ICU) (34.1% in AS vs. 48.1% in AG, p = 0.161); there was not a sufficient number of events of postoperative renal failure. 30-day mortality of 9.1% (6.8% in SA vs. 11.1% in AG, p = 0.464). Based on the results of this cohort, there is no evidence of association between the type of anesthesia and the outcomes of the study. Conclusions: No association was found between the incidence of postoperative delirium, stay in intensive care unit and the type of anesthesia, although a protective tendency is evidenced in those who receive anesthesia with sedation. It was not possible to evaluate the outcomes of renal failure and mortality due to an insufficient number of events in the cohort.
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dc.format	application/pdf
dc.language	spa
dc.publisher	Universidad Autónoma de Bucaramanga UNAB
dc.publisher	Facultad Ciencias de la Salud
dc.publisher	Maestría en Métodos para la Producción y Aplicación de Conocimiento Científico en Salud
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dc.rights	http://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.rights	Abierto (Texto Completo)
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	http://purl.org/coar/access_right/c_abf2
dc.rights	Atribución-NoComercial-SinDerivadas 2.5 Colombia
dc.subject	Medical sciences
dc.subject	Health sciences
dc.subject	Aortic valve implant
dc.subject	Transcatheter
dc.subject	Aorta
dc.subject	Aortic stenosis
dc.subject	General anesthesia
dc.subject	Sedation
dc.subject	Anesthesia in cardiology
dc.subject	Blood circulation
dc.subject	Surgery
dc.subject	Ciencias médicas
dc.subject	Anestesia en cardiología
dc.subject	Circulación sanguínea
dc.subject	Cirugía
dc.subject	Ciencias de la salud
dc.subject	Implante valvular aórtico
dc.subject	Transcatéter
dc.subject	Aorta
dc.subject	Estenosis aortica
dc.subject	Anestesia general
dc.subject	Sedación
dc.title	Anestesia general vs. sedación: desenlaces de falla renal, delirium y estancia en la unidad de cuidados intensivos después del implante valvular aórtico transcatéter. Estudio de cohorte retrospectivo monocéntrico (Fundación Cardiovascular de Colombia, periodo 2010-2019)
dc.title	General anesthesia vs. sedation: outcomes of renal failure, delirium, and stay in the intensive care unit after transcatheter aortic valve implantation. Monocentric retrospective cohort study (Fundación Cardiovascular de Colombia, period 2010-2019)
dc.type	Thesis
dc.type	info:eu-repo/semantics/ masterThesis
dc.type	Tesis
dc.type	http://purl.org/coar/resource_type/c_bdcc
dc.type	info:eu-repo/semantics/acceptedVersion
dc.type	http://purl.org/redcol/resource_type/TM
dc.coverage	Bucaramanga (Santander, Colombia)
dc.coverage	2010-2019