Anesthetic aspects on implantation of the Baroreflex Activation Therapy Neo system
Published on: 2018-12-24
Background Baroreflex activation therapy (BAT) is effective therapy for resistant arterial hypertension (HTN) by attenuation of sympathetic activity. The aim of this study was to systematically investigate the effects of anesthetic agents as well as co-morbidities on the baroreceptor reflex during electrode placement. Methods From 2012 to January 2015 patients treated with BAT for uncontrolled resistant HTN were consecutively analyzed. Analyses of applied anesthetics, blood pressure (BP)-relevant medicaments, intra- and post-operative BP and heart rate, device electrode positioning as well as their mutual interaction were performed. Results A BAT device was implanted in 55 patients in generalized anesthesia using anesthetic agents without depression of the baroreflex (etomidate as induction and midazolam and remifentanil as maintenance therapy) in all cases. Anesthesia was safe in all but one case with anaphylactic reaction on gelatine infusion. The use of the vasopressor norepinephrine had neither influence on BP-decrease during mapping (p=0.36) nor on 6 months responder rate (p=0.55). BP drop during mapping was not predictive for therapy response (p=0.91) Conclusion Agents of choice for general anesthesia for implantation of BAT-devices are etomidate, midazolam and remifentanil. It still remains to be elucidated whether mapping procedure could benefit from an unblunted baroreceptor reflex using regional anesthesia in the absence of any anesthetics.