High-flow oxygenation therapy for a sedated elderly frail patient with hiccups undergoing transcatheter aortic valve implantation.

Abstract

Background: Transcatheter aortic valve implantation (TAVI) can be performed under sedation, but body movements may lower the efficacy of the procedure and may increase the risk of complications, such as cardiac tamponade. Additional sedatives and analgesics may be required to prevent body movements; this would increase the risk of upper airway obstruction and of respiratory depression. We report a frail patient with hypoxemia and hiccups, in whom high-flow nasal oxygenation facilitated TAVI by effectively inhibiting body movements and respiratory complications.

Case presentation: In an 82-year-old patient with severe aortic stenosis, heart failure, hypoxemia, and hiccups, TAVI was planned under sedation with dexmedetomidine, fentanyl, and ketamine. High-flow nasal oxygenation effectively prevented hiccups and associated body movements, and prevented upper airway obstruction and respiratory depression, during TAVI.

Conclusions: High-flow nasal oxygenation therapy is potentially useful during cardiac catheterization procedure under monitored anesthesia care, in elderly frail patients with reduced cardiopulmonary function.