1
|
Moury PH, Pasquier V, Greco F, Arvieux JL, Alves-Macedo S, Richard M, Casez-Brasseur M, Skaare K, Jacon P, Durand M, Bedague D, Jaber S, Bosson JL, Albaladejo P. A randomized controlled trial of the intraoperative use of noninvasive ventilation versus supplemental oxygen by face mask for procedural sedation in an electrophysiology laboratory. Can J Anaesth 2023; 70:1182-1193. [PMID: 37268802 DOI: 10.1007/s12630-023-02495-2] [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: 07/26/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 06/04/2023] Open
Abstract
PURPOSE The efficacy of noninvasive ventilation (NIV) during procedures that require sedation and analgesia has not been established. We evaluated whether NIV reduces the incidence of respiratory events. METHODS In this randomized controlled trial, we included 195 patients with an American Society of Anesthesiologists Physical Status of III or IV during electrophysiology laboratory procedures. We compared NIV with face mask oxygen therapy for patients under sedation. The primary outcome was the incidence of respiratory events determined by a computer-driven blinded analysis and defined by hypoxemia (peripheral oxygen saturation < 90%) or apnea/hypopnea (absence of breathing for 20 sec on capnography). Secondary outcomes included hemodynamic variables, sedation, patient safety (composite scores of major or minor adverse events), and adverse outcomes at day 7. RESULTS A respiratory event occurred in 89/98 (95%) patients in the NIV group and in 69/97 (73%) patients with face masks (risk ratio [RR], 1.29; 95% confidence interval [CI], 1.13 to 1.47; P < 0.001). Hypoxemia occurred in 40 (42%) patients in the NIV group and in 33 (34%) patients with face masks (RR, 1.21; 95% CI, 0.84 to 1.74; P = 0.30). Apnea/hypopnea occurred in 83 patients (92%) in the NIV group vs 65 patients (70%) with face masks (RR, 1.32; 95% CI, 1.14 to 1.53; P < 0.001). Hemodynamic variables, sedation, major or minor safety events, and patient outcomes were not different between the groups. CONCLUSIONS Respiratory events were more frequent among patients receiving NIV without any safety or outcome impairment. These results do not support the routine use of NIV intraoperatively. STUDY REGISTRATION ClinicalTrials.gov (NCT02779998); registered 4 November 2015.
Collapse
Affiliation(s)
- Pierre-Henri Moury
- HP2 Laboratory, U1042, Grenoble Alpes University, Grenoble, France.
- Pôle Anesthésie-Réanimation, Réanimation Cardiovasculaire et Thoracique, CHU Grenoble Alpes, CS 10217, Grenoble Cedex 9, France.
| | | | - Flora Greco
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | | | | | - Marion Richard
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | | | - Kristina Skaare
- Department of Biostatistics, Public Health, ThEMAS, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Peggy Jacon
- Department of Cardiology, CHU Grenoble Alpes, Grenoble, France
| | - Michel Durand
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Damien Bedague
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Samir Jaber
- Intensive Care Unit, Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Université Montpellier 1, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Jean-Luc Bosson
- Department of Biostatistics, Public Health, ThEMAS, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | | |
Collapse
|
2
|
Lachlan T, He H, Aggour H, Sahota P, Harvey S, Patel K, Foster W, Yusuf S, Panikker S, Dhanjal T, Dandekar U, Barker T, Parmar J, Kuehl M, Osman F. Safety and feasibility of trans-venous cardiac device extraction using conscious sedation alone-Implications for the post-COVID-19 era. J Arrhythm 2021; 37:1522-1531. [PMID: 34887957 PMCID: PMC8637087 DOI: 10.1002/joa3.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) for implantable cardiac-devices is traditionally performed under general anesthesia (GA). This can lead to greater risk of exposure to COVID-19, longer recovery-times and increased procedural-costs. We report the feasibility/safety of TLE using conscious-sedation alone with immediate GA/cardiac-surgery back-up if needed. METHODS Retrospective case-series of consecutive TLEs performed using conscious-sedation alone between March 2016 and December 2019. All were performed in the electrophysiology-laboratory using intravenous Fentanyl, Midazolam/Diazepam with a stepwise approach using locking-stylets/cutting-sheaths, including mechanical-sheaths. Baseline patient-characteristics, procedural-details and TLE outcomes (including procedure-related complications/death) were recorded. RESULTS A total of 130 leads were targeted in 54 patients, mean age ± SD 74.6 ± 11.8years, 47(87%) males; dual-chamber pacemakers (n = 26; 48%), cardiac resynchronization therapy-defibrillators (n = 17; 31%) and defibrillators (n = 8; 15%) were commonest extracted devices. Mean ± SD/median (range) lead-dwell times were 11.0 ± 8.8/8.3 (0.3-37) years, respectively. Extraction indications included systemic infection (n = 23; 43%) and lead/pulse-generator erosion (n = 27; 50%); mean 2.1 ± 2.0 leads were removed per procedure/mean procedure-time was 100 ± 54 min. Local anesthetic (LA) was used for all (mean-dose: 33 ± 8 ml 1% lidocaine), IV drug-doses used (mean ± SD) were: midazolam: 3.95 ± 2.44 mg, diazepam: 4.69 ± 0.89 mg and fentanyl: 57 ± 40 µg. Complete lead-extraction was achieved in 110 (85%) leads, partial lead-extraction (<4 cm-fragment remaining) in 5 (4%) leads. Sedation-related hypotension requiring IV fluids occurred in 2 (managed without adverse-consequences) and hypoxia requiring additional airway-management in none. No procedural deaths occurred, one patient required emergency cardiac surgery for localized ventricular perforation, nine had minor complications (transient hypotension/bradycardia/pericardial effusion not requiring intervention). CONCLUSION TLE undertaken using LA/conscious-sedation was safe/feasible in our series and associated with good clinical outcome/low procedural complications. Reduced risk of aerosolization of COVID-19 and quicker patient recovery/reduced anesthetic risk are potential benefits that warrant further study.
Collapse
Affiliation(s)
- Thomas Lachlan
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Hejie He
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Hesham Aggour
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Preet Sahota
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Samuel Harvey
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Kiran Patel
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Will Foster
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- Worcester Royal HospitalWorcesterUK
| | - Shamil Yusuf
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Sandeep Panikker
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Tarv Dhanjal
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| | - Uday Dandekar
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Thomas Barker
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Jitendra Parmar
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Michael Kuehl
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
| | - Faizel Osman
- Department of CardiologyUniversity Hospitals Coventry & Warwickshire NHS TrustCoventryUK
- University of Warwick (Medical School)CoventryUK
| |
Collapse
|
3
|
|
4
|
Bode K, Whittaker P, Lucas J, Müssigbrodt A, Hindricks G, Richter S, Doering M. Deep sedation for transvenous lead extraction: a large single-centre experience. Europace 2019; 21:1246-1253. [DOI: 10.1093/europace/euz131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/11/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Transvenous lead extraction for cardiac implantable electronic devices (CIED) is of growing importance. Nevertheless, the optimal anaesthetic approach, general anaesthesia vs. deep sedation (DS), remains unresolved. We describe our tertiary centre experience of the feasibility and safety of DS.
Methods and results
Extraction procedures were performed in the electrophysiology (EP) laboratory by two experienced electrophysiologists. We used intravenous Fentanyl, Midazolam, and Propofol for DS. A stepwise approach with locking stylets, dilator sheaths, and mechanical sheaths via subclavian, femoral, or internal jugular venous access was utilized. Patient characteristics and procedural data were collected. Logistic regression models were used to identify parameters associated with sedation-related complications. Extraction of 476 leads (dwelling time/patient 88 ± 49 months, 30% ICD leads) was performed in 220 patients (64 ± 17 years, 80% male). Deep sedation was initiated with bolus administration of Fentanyl, Midazolam, and Propofol; mean doses 0.34 ± 0.12 μg/kg, 24.3 ± 6.8 μg/kg, and 0.26 ± 0.13 mg/kg, respectively. Deep sedation was maintained with continuous Propofol infusion (initial dose 3.7 ± 1.1 mg/kg/h; subsequently increased to 4.7 ± 1.2 mg/kg/h with 3.9 ± 2.6 adjustments) and boluses of Midazolam and Fentanyl as indicated. Sedation-related episodes of hypotension, requiring vasopressors, and hypoxia, requiring additional airway management, occurred in 25 (11.4%) and 5 (2.3%) patients, respectively. These were managed without adverse consequences. Five patients (2.3%) experienced major intraprocedural complications; there were no procedure-related deaths. All of our logistic regression models indicated intraprocedural support was associated with administration higher Fentanyl doses.
Conclusion
Transvenous lead extraction under DS in the EP laboratory is a safe procedure with high success rates when performed by experienced staff.
Collapse
Affiliation(s)
- Kerstin Bode
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Peter Whittaker
- Department of Emergency Medicine, Cardiovascular Research Institute, Wayne State University, Detroit, MI, USA
| | - Johannes Lucas
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Andreas Müssigbrodt
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| |
Collapse
|
5
|
Hernandez-Perez AL, Gallardo-Hernandez AG, Ordoñez-Espinosa G, Martinez-Carrillo B, Bermudez-Ochoa MG, Revilla-Monsalve C, Sanchez-Lopez JA, Saturno-Chiu G, Leder R. Significant and safe reduction of propofol sedation dose for geriatric population undergoing pacemaker implantation: randomized clinical trial. Aging Clin Exp Res 2018; 30:1233-1239. [PMID: 29464504 DOI: 10.1007/s40520-018-0914-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/09/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A previous multidisciplinary pilot study based on computer simulations for the geriatric population showed that a dose of 0.5 mg/kg/h of propofol could sedate patients older than 65 for pacemaker implantation. The present study validates that the pacemaker implantation can be done in the elderly using 0.5-1 mg/kg/h of propofol with hemodynamic stability. METHODS 66 patients from 65 to 88 years old scheduled for pacemaker implantation were randomly assigned one of three doses of propofol. The first group received 2 mg/kg/h of propofol (P2) that is within normal range of the sedation dose. The second group received 1 mg/kg/h (P1) dose and the third group received the dose of 0.5 mg/kg/h (P0.5) according to the simulation-predicted dose for geriatric populations. RESULTS All patients kept MAP between 76 and 85 mmHg, with no hypotension episodes in any of the groups; therefore, they were all hemodynamically stable during the procedure. BIS was between 80 and 65 during the pacemaker implantation for the three groups, BIS of group P2 was significantly lower than the other groups. BIS in groups P1 and P0.5 was within the appropriated range for moderate sedation. Brice was positive for auditory recalls only when there was arousing noise in the operating room. CONCLUSIONS Moderate sedation, adequate for pacemaker implantation, can be achieved infusing 0.5-1 mg/kg/h of propofol in elderly patients when the patient has proper analgesia management at the device implantation site. The second important condition is to avoid unnecessary and alerting auditory and mechanical stimuli in the operating room, so that the patient will remain calm.
Collapse
Affiliation(s)
| | - Ana Gabriela Gallardo-Hernandez
- Unidad de Investigación Médica en Enfermedades Metabólicas, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
| | - German Ordoñez-Espinosa
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | | | | | - Cristina Revilla-Monsalve
- Unidad de Investigación Médica en Enfermedades Metabólicas, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Jose Antonio Sanchez-Lopez
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Guillemo Saturno-Chiu
- Unidad Médica de Alta Especialidad de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | - Ronald Leder
- Sleep Research Society, Mexico City, Mexico
- IEEE Engineering in Medicine and Biology, Mexico City, Mexico
| |
Collapse
|
6
|
McCanta AC, Perry JC. Cardiac resynchronization therapy in children with heart failure. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
Gerstein NS, Young A, Schulman PM, Stecker EC, Jessel PM. Sedation in the Electrophysiology Laboratory: A Multidisciplinary Review. J Am Heart Assoc 2016; 5:JAHA.116.003629. [PMID: 27412904 PMCID: PMC4937286 DOI: 10.1161/jaha.116.003629] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Andrew Young
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR
| | - Peter M Schulman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Peter M Jessel
- Knight Cardiovascular Institute, VA Portland Health Care System, Portland, OR
| |
Collapse
|
8
|
Timmers L, Van Heuverswyn F, De Wilde H, Jordaens L. Evaluating current implantable cardioverter defibrillator implantation procedures: can common complications be minimised? Expert Rev Cardiovasc Ther 2016; 14:579-89. [DOI: 10.1586/14779072.2016.1144471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
9
|
Trouvé-Buisson T, Albaladejo P. Reply to: anaesthesiological support in a cardiac electrophysiology laboratory. Eur J Anaesthesiol 2014; 31:238. [PMID: 24296820 DOI: 10.1097/eja.0000000000000030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Thibaut Trouvé-Buisson
- From the Department of Anaesthesia and Intensive Care Medicine, Grenoble University Hospital, La Tronche, Isère, France
| | | |
Collapse
|
10
|
Anaesthetist support during sedation for patients undergoing minimally invasive procedures outside the operating room. Eur J Anaesthesiol 2013; 30:655-7. [DOI: 10.1097/eja.0b013e3283613ff9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|