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However, this state may predispose patients to periodic limb movements (PLMs), which can cause unintended procedural risk during sedation. We aimed to determine the incidence of PLMs during dexmedetomidine-based multimodal sedation for transcatheter aortic valve implantation (TAVI) and explore associations with the need for conversion to general anesthesia. In this prospective observational study, 35 consecutive patients (mean age 81\u2009\u00b1\u20096 years; 17 female, 18 male) undergoing TAVI over a two-month period from October 2021 to the end of November 2021 were monitored using standard anesthesia monitoring, processed electroencephalography (pEEG) monitoring using Narcotrend 3-lead frontal EEGs (Narcotrend, Hannover, Germany), and bilateral ankle actimetry (SOMNOwatch\u2122 plus). Sedation was administered according to our institutional protocol, beginning with a dexmedetomidine loading dose (0.5\u00a0\u00b5g kg\u207b\u00b9), followed by titration of the infusion between 0.2 and 1.5\u00a0\u00b5g kg\u207b\u00b9 h\u207b\u00b9. Additional propofol or fentanyl boluses were administered as clinically indicated by the responsible anesthesiologist. Actimetry, EEG patterns, and intraoperative events were analyzed. PLMs (2\u20136 movements\/min; most commonly 3\u20135 movements\/min) were observed in 20 of 35 patients (57%) and all conversions to general anesthesia (5\/5, 100%) occurred in the PLM-positive group, highlighting a potential clinical impact on procedural stability. In the 19 patients with complete EEG datasets, Narcotrend indices during dexmedetomidine-only sedation averaged 96.6\u2009\u00b1\u20092.6, consistent with an awake\u2013sedate EEG pattern. Following propofol administration, the index decreased to 39.3\u2009\u00b1\u200920.0, corresponding to a very large effect size (Cohen\u2019s d\u2009=\u20092.85). Five conversions to general anesthesia were necessary in patients with PLMs, because of restlessness, although the severity of PLMs did not predict conversion. No patient had a known history of restless legs syndrome (RLS); prior neurological disease showed no consistent association with PLM occurrence. PLMs are common during dexmedetomidine sedation for TAVI in elderly patients and may need conversion to general anesthesia. While dexmedetomidine offers cognitive benefits, the potential for movement-related procedural risk warrants increased monitoring and consideration during patient selection and anesthetic planning. Further studies comparing sedation-induced and natural sleep PLMs are needed.<\/jats:p>","DOI":"10.1007\/s10877-026-01421-3","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:12:28Z","timestamp":1771917148000},"page":"589-600","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Periodic limb movements during sedation and general anesthesia in elderly patients: a prospective observational study"],"prefix":"10.1007","volume":"40","author":[{"given":"Katalin","family":"Arki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Harte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne","family":"Frickmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren","family":"Hight","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Saxena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mia","family":"Gisselbaek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony R.","family":"Absalom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Berger-Estilita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Lersch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"1421_CR1","doi-asserted-by":"crossref","unstructured":"Brown EN, Pavone KJ, Naranjo M. 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Darren Hight has received honoraria for speaking from Medtronic. Sarah Saxena is a member of the Board of Directors of the ESAIC and has received speaker\u2019s fees from Medtronic and Merck.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}