Ambulatory anesthesia for the cardiac catheterization and electrophysiology laboratories

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness-A Review for the Cardiac Anesthesiologist

The American College of Cardiology, in collaboration with the American Society of Nuclear Cardiology, Heart Rhythm Society, Mended Hearts, North American Society for Cardiovascular Imaging, Society for Cardiovascular Angiography and Interventions, Society for Cardiovascular Computed Tomography, and Society of Nuclear Medicine and Molecular Imaging, recently published a consensus document recommending best practices for the use of ionizing radiation in cardiovascular medicine. With the increase in number and complexity of catheter-based cardiovascular interventions, cardiothoracic anesthesiologists are being requested to consult and provide care for these patients. This review summarizes the salient portions of the consensus document as it pertains to the anesthesiologist. Radiation exposure for both patients and providers should be minimized to be as low as reasonably achievable. For the anesthesiologist involved in the procedure, the authors recommend wearing protective garments including apron, vest, neck collar, and glasses of at least 0.25-mm lead or lead equivalent. The addition of a portable shield also is strongly recommended. The anesthesiologist should maintain the maximum distance allowable from the x-ray source, remembering that radiation intensity is inversely proportional to the square of the distance from the x-ray source. Monitoring radiation exposure is done best by both collar and under-apron film badge. A 0.5-mm lead-equivalent apron is expected to shield approximately 95% of the radiation. By using these recommendations, the anesthesiologist should be able to keep radiation exposure under 20 mSv per year as recommended by the International Commission on Radiation Protection.