Jacobs Journal of Anesthesiology and Research

Anesthetic aspects on implantation of the Baroreflex Activation Therapy Neo system

* Daniel Heise
Department Of Anesthesiology, Georg-August-University, Göttingen, Germany

*Corresponding Author:
Daniel Heise
Department Of Anesthesiology, Georg-August-University, Göttingen, Germany
Email:dheise1@gwdg.de

Published on: 2018-12-24

Abstract

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.

Keywords

Anaesthesia; Baroreflex Activation Therapy; Heart Failure; Resistant Hypertension

Introduction

Baroreflex Activation Therapy (BAT) represents a novel option in the treatment of resistant hypertension or congestive heart failure with reduced ejection fraction (HFrEF) by modulating the autonomic nervous system. In BAT, a programmable pulse generator (Rheos™ System, CVRx. Inc.) is placed underneath the fascia of the pectoralis major muscle and connected to an unipolar electrode (CVRx., Mod. 1030, 1032 and 1036) applied on carotid sinus to apply continuous baroreflex activation. This programmable pulse generator is capable of delivering between 1 and 20 mA in a temporally variable pattern, via an electrode that is placed on the carotid bulb, requiring open surgical exposure and intraoperative mapping for the site of maximal hemodynamic effect.The device mimics the body’s blood pressure (BP) regulator by electrically activating the baroreceptors that sense an aberrant increase in the BP level. Bypassing mechanotransduction by electrical activation of the carotid sinus provides sustained afferent baroreceptor input into the brain, and consequently chronically suppresses central sympathetic outflow but also augments parasympathetic activity. Due to the aforementioned effects, the BAT among others lowers BP improves cardiac function and glucose metabolism[8] but also exerts vaso- and nephroprotective effects.