Comparison between monitored anesthesia care and general anesthesia in patients undergoing device closure of atrial septal defect

Background: Percutaneous atrial septal defect (ASD) device closure is usually performed under general anesthesia (GA) because it can ensure protection of the airway from the effects of insertion of the transesophageal echocardiogram probe insertion. However, recent studies have suggested that this procedure can be performed safely under deep sedation also. Thus, we compared the efficacy of using monitored anesthesia care (MAC) with deep sedation versus GA to perform this procedure and the post-procedural outcomes and incidence of complications associated with these two methods of anesthesia. Methods: We retrospectively analyzed cases involving 311 patients who underwent ASD device closures from January 2011 to December 2015. The demographics, laboratory values, echocardiographic findings, and intraoperative data of these patients were assessed. GA was induced with a continuous infusion of propofol and remifentanil using a target control infusion pump. MAC with deep sedation was performed by using a continuous infusion of dexmedetomidine and remifentanil. The primary outcome of the study was the overall complication rate that included the incidence of aspiration pneumonia, sore throat, dysphagia, vocal cord palsy, neurologic complication, device-related complications, and other minor complications during the procedure; and the secondary outcomes were the turnover time, procedure time, and duration of hospital stay. Results: No significant differences were observed in the complication rate and length of the hospital stay between the MAC group and the GA group. However, the turnover time was significantly longer in the GA group than in the MAC group (56.2 +/- 13.3 vs. 51.0 +/- 15.4 min, P=0.004). Conclusions: MAC under deep sedation is an effective and safe anesthetic option comparable to GA for performing percutaneous ASD device closures.