Inclusion Criteria:  • Patients undergoing TF-TAVI.  Both sexes. Age 18 and above  Exclusion Criteria:  • Inability to tolerate supine position as in patients with musculoskeletal disease or back pain, OR in patients with congestive heart failure or with obstructive sleep apnea.  Patients with severe pulmonary hypertension (PAP>60 mmhg) Barrier to communications as language barrier or dementia. Patients' preference of general anesthesia. Surgical consideration as transapical, subclavian approach, extensive TEE requirements. Patients with history of allergy to any drugs used. Patients with psychiatric disease. Patients with neurocognitive or neurodegenerative disease. Secondary exclusion criteria include abortion of the procedure, perioperative emergency conversion to general anesthesia and the need to cardiopulmonary resuscitation so the primary endpoint couldn't be detected in these conditions.