1
|
Monaco F, D'Andria Ursoleo J, Lerose CC, Barucco G, Licheri M, Della Bella PE, Fioravanti F, Gulletta S. Anaesthetic management of paediatric patients undergoing electrophysiology study and ablation for supraventricular tachycardia: A focused narrative review. J Clin Anesth 2024; 93:111361. [PMID: 38118231 DOI: 10.1016/j.jclinane.2023.111361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 12/22/2023]
Abstract
Every year, 80,000-100,000 ablation procedures take place in the United States and approximately 1% of these involve paediatric patients. As the paediatric population undergoing catheter ablation to treat dysrhythmia is constantly growing, involvement of anaesthesiologists in the cardiac electrophysiology laboratory is simultaneously increasing. Compared with the adult population, paediatric patients need deeper sedation or general anaesthesia (GA) to guarantee motionlessness and preserve comfort. As a result, the anaesthesiologist working in this setting should keep in mind heart physiopathology as well as possible interactions between anaesthetic drugs and arrhythmia. In fact, drug-induced suppression of accessory pathways (APs) conduction capacity is a major concern for completing a successful electrophysiology study (EPS). Nevertheless, the literature on this topic is scarce and the optimal type of anaesthesia in EPS and ablation procedures in children is still controversial. Thus, the main goal of the present review is to collect the literature published so far on the effects on cardiac conduction tissue of the drugs commonly employed for sedation/GA in the cath lab for EPS and ablation procedures to treat supraventricular tachycardia in patients aged <18 years.
Collapse
Affiliation(s)
- Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Jacopo D'Andria Ursoleo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Gaia Barucco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Licheri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Emilio Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Fioravanti
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Gulletta
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
2
|
Elhaddad AM, Hefnawy SM, El-Aziz MA, Ebraheem MM, Mohamed AK. Pectoral nerve blocks for transvenous subpectoral pacemaker insertion in children: a randomized controlled study. Korean J Anesthesiol 2023; 76:424-432. [PMID: 36632640 PMCID: PMC10562074 DOI: 10.4097/kja.22681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Postoperative pain management after pacemaker insertion routinely requires opioid agents, nonsteroidal anti-inflammatory drugs, or paracetamol. However, interest in opioid-sparing multimodal pain management to minimize postoperative narcotic use has increased recently. This study aimed to assess the pectoral nerve (PECS) block versus standard treatment on postoperative pain control and opioid consumption in pediatric patients after transvenous subpectoral pacemaker insertion. METHODS In this randomized controlled study, 40 pediatric patients underwent transvenous subpectoral pacemaker insertion with either congenital or postoperative complete heart block. Patients were randomly assigned to two groups: Group C (control) received conventional analgesic care without any block and Group P (pectoral) received a PECS block. Demographics, procedural variables, postoperative pain, and postoperative opioid consumption were compared between the two groups. RESULTS In children undergoing transvenous subpectoral pacemaker insertion, the PECS block was associated with a longer procedure time; however, the cumulative dose of fentanyl and atracurium was reduced and the hemodynamic profile was superior in Group P compared with Group C intraoperatively. Postoperatively, the PECS block was associated with lower postprocedural pain scores, which was reflected by the longer interval before the first call for rescue analgesia and lower postoperative morphine consumption, without an increase in the rate of complications. CONCLUSION Ultrasound-guided PECS blocks are associated with a good intraoperative hemodynamic profile, reduced postoperative pain scores, and lower total opioid consumption in children undergoing transvenous subpectoral pacemaker placement.
Collapse
Affiliation(s)
- Ahmed Mohamed Elhaddad
- Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children’s Hospital, Cairo, Egypt
| | - Salwa Mohamed Hefnawy
- Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children’s Hospital, Cairo, Egypt
| | - Mohamed Abd El-Aziz
- Department of Anesthesia, Faculty of Medicine, Misr University for Science and Technology, Cairo, Egypt
| | - Mahmoud Mostafa Ebraheem
- Department of Anesthesia, Faculty of Medicine, Misr University for Science and Technology, Cairo, Egypt
| | - Ahmed Kareem Mohamed
- Department of Anesthesia, Kasr Alainy, Cairo University/Abo Elreesh Children’s Hospital, Cairo, Egypt
| |
Collapse
|
3
|
Gu Y, Lander HL, Abozaid R, Chang FM, Clifford HS, Aktas MK, Lebow BF, Panda K, Wyrobek JA. Anesthetic Management and Considerations for Electrophysiology Procedures. Adv Anesth 2022; 40:131-147. [PMID: 36333043 DOI: 10.1016/j.aan.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The number of electrophysiology (EP) procedures being performed has dramatically increased in recent years. This escalation necessitates a full understanding by the general anesthesiologist as to the risks, specific considerations, and comorbidities that accompany these now common procedures. Procedures reviewed in this article include atrial fibrillation and flutter ablation, supraventricular tachycardia ablation, ventricular tachycardia ablation, electrical cardioversion, pacemaker insertion, implantable cardioverter-defibrillator (ICD) insertion, and ICD lead extraction. General anesthetic considerations as well as procedure-specific concerns are discussed. Knowledge of these procedures will add to the anesthesiologist's armamentarium in safely caring for patients in the EP laboratory.
Collapse
Affiliation(s)
- Yang Gu
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA
| | - Heather L Lander
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA
| | - Ravie Abozaid
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA
| | - Francis M Chang
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA
| | - Hugo S Clifford
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA
| | - Mehmet K Aktas
- Department of Medicine, Cardiology, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Floor G, Strong Ambulatory Care Facility, Rochester, NY 14642, USA
| | - Brandon F Lebow
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA
| | - Kunal Panda
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA
| | - Julie A Wyrobek
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA.
| |
Collapse
|
4
|
B Hesselson A, Hesselson H. Hemodynamic Management of Patients with Ejection Fraction < 50% Undergoing Pulmonary Vein Ablation. J Atr Fibrillation 2021; 13:20200439. [PMID: 34950346 PMCID: PMC8691288 DOI: 10.4022/jafib.20200439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/31/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022]
Abstract
There is no consensus regarding optimal methodology forblood pressure monitoring inpatients with a depressed ejection fraction undergoingcatheter ablationfor atrial fibrillation. Our goalswere to determine ifhemodynamicmanagementdifferences exist during radiofrequency ablation for atrial fibrillation in patients with and without an ejection fraction< 50%, and whether management was influenced by the utilization of invasive arterial blood pressure monitoring. This single-center trial retrospectively compared blood pressure management during catheterablation of atrial fibrillationin all patients with an ejection fraction< 50% over a 2-year span (n=44), and compared to an age-matched cohort with preserved ejection fraction ablated over the same span in time (n=44). Blood pressure was not significantly managed differently between the groups, and did not appear to be influenced by the use of invasive arterial blood pressure monitoring.Hemodynamic management is similar across the spectrum of ejection fraction, regardless of invasive arterial blood pressure monitoring, which challenges the need for invasive arterial blood pressure monitoringduringcatheter ablation ofatrial fibrillationin left ventricular systolic dysfunction.
Collapse
Affiliation(s)
- Aaron B Hesselson
- University of Kentucky Division of Cardiovascular Medicine, 900 South Limestone Street, CTW 305D, Lexington, KY 40536
| | - Heather Hesselson
- University of Kentucky, College of Pharmacy, 789 S Limestone, Lexington, KY 40508
| |
Collapse
|
5
|
Vladinov G, Fermin L, Longini R, Ramos Y, Maratea E. Choosing the anesthetic and sedative drugs for supraventricular tachycardia ablations: A focused review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1555-1563. [DOI: 10.1111/pace.13511] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Greta Vladinov
- School of Nursing and Health Studies; University of Miami Health System; Miami FL USA
| | - Lilibeth Fermin
- Department of Anesthesiology, Miller School of Medicine; University of Miami Health System; Miami FL USA
| | - Renee Longini
- School of Nursing and Health Studies; University of Miami Health System; Miami FL USA
| | - Yanett Ramos
- School of Nursing and Health Studies; University of Miami Health System; Miami FL USA
| | - Edward Maratea
- Department of Anesthesiology, Miller School of Medicine; University of Miami Health System; Miami FL USA
| |
Collapse
|
6
|
Demystifying the EP Laboratory: Anesthetic Considerations for Electrophysiology Procedures. Int Anesthesiol Clin 2018; 56:98-119. [DOI: 10.1097/aia.0000000000000201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Maxwell BG, Harrington KB, Hill CC, Banayan JM, Spiess BD. CASE 4-2014: ascending aortic pseudoaneurysm repair with deep hypothermic circulatory arrest in an adult congenital heart disease patient with heparin-induced thrombocytopenia. J Cardiothorac Vasc Anesth 2014; 28:810-8. [PMID: 24656300 DOI: 10.1053/j.jvca.2013.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Bryan G Maxwell
- Department of Anesthesiology, Stanford University Medical Center, Stanford, CA.
| | | | - Charles C Hill
- Department of Anesthesiology, Stanford University Medical Center, Stanford, CA
| | - Jennifer M Banayan
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Bruce D Spiess
- Department of Anesthesiology and Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
| |
Collapse
|