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Lee S, Lee J, Hwang SY, Ju JW, Nam K, Ahn HJ, Lee SR, Choi EK, Jeon Y, Cho YJ. Remimazolam-flumazenil provides fast recovery from general anesthesia compared to propofol during radiofrequency catheter ablation of atrial fibrillation. Sci Rep 2024; 14:12660. [PMID: 38831029 PMCID: PMC11148142 DOI: 10.1038/s41598-024-63578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/30/2024] [Indexed: 06/05/2024] Open
Abstract
The optimal anesthetic agent for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) and its impact on the recovery profiles remain uncertain. We compared the recovery and hemodynamic parameters between the remimazolam-flumazenil and propofol groups during RFCA. Patients were randomized into the remimazolam-flumazenil and propofol groups. The primary outcome measure was the time to eye opening following the discontinuation of anesthetic agents. Secondary outcomes included time to extubation, time to discharge from the operating room, intraprocedural hemodynamic variables and postoperative quality outcomes. Fifty-three patients were included in the final analysis (n = 26 in the remimazolam-flumazenil and n = 27 in the propofol group). The time to eye opening was significantly shorter in the remimazolam-flumazenil group compared to the propofol group (median [interquartile range]: 174 [157-216] vs. 353 [230-483] s, P < 0.001). The mean blood pressure and bispectral index were significantly higher in the remimazolam-flumazenil group compared to the propofol group (mean difference [95% CI], 7.2 [1.7-12.7] mmHg and 6 [3-8]; P = 0.011 and < 0.001, respectively), which were within target ranges in both groups. Other secondary outcomes were comparable between the groups. Consequently, remimazolam emerges as a promising anesthetic agent, characterized by rapid recovery and stable hemodynamics, during RFCA of AF.Trial registration: NCT05397886.
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Affiliation(s)
- Seohee Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jaemoon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University College of Medicine, Seoul, Republic of Korea
| | - So Yeong Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yunseok Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Youn Joung Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Siddiqui MN, Henley E, Xue B. Refractory atrial fibrillation with rapid ventricular response as a heralding sign of propofol infusion syndrome in a patient with COVID-19. BMJ Case Rep 2023; 16:16/5/e252763. [PMID: 37142288 PMCID: PMC10163436 DOI: 10.1136/bcr-2022-252763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
A woman in her 40s was transferred to the medical intensive care unit due to severe COVID-19 infection causing respiratory failure. Her respiratory failure worsened rapidly, requiring intubation and continuous sedation with fentanyl and propofol infusions. She required progressive increases in the rates of the propofol infusion, as well as addition of midazolam and cisatracurium due to ventilator dyssynchrony. To support the high sedative doses, norepinephrine was administered as a continuous infusion. She developed atrial fibrillation with rapid ventricular response, with rates ranging between 180 and 200 s which did not respond to intravenous adenosine, metoprolol, synchronised cardioversion or amiodarone. A blood draw revealed lipaemia, and triglyceride levels were noted to be elevated to 2018. The patient developed high-grade fevers up to 105.3 and acute renal failure with severe mixed respiratory and metabolic acidosis, indicating propofol-related infusion syndrome. Propofol was promptly discontinued. An insulin-dextrose infusion was initiated which improved patient's fevers and hypertriglyceridaemia.
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Affiliation(s)
| | - Elizabeth Henley
- Internal medicine, St Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | - Bing Xue
- Critical care/Pulmonology, St Joseph Mercy Health System, Ann Arbor, Michigan, USA
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Tajima K, Yamakawa K, Kuwabara Y, Miyazaki C, Sunaga H, Uezono S. Propofol anesthesia decreases the incidence of new-onset postoperative atrial fibrillation compared to desflurane in patients undergoing video-assisted thoracoscopic surgery: A retrospective single-center study. PLoS One 2023; 18:e0285120. [PMID: 37130135 PMCID: PMC10153745 DOI: 10.1371/journal.pone.0285120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/16/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) increases postoperative morbidity, mortality, and length of hospital stay. Propofol is reported to modulate atrial electrophysiology and the cardiac autonomic nervous system. Therefore, we retrospectively examined whether propofol suppresses POAF in patients undergoing video-assisted thoracoscopic surgery (VATS) compared to desflurane. METHODS We retrospectively recruited adult patients who underwent VATS during the period from January 2011 to May 2018 in an academic university hospital. Between continuous propofol and desflurane administration during anesthetic maintenance, we investigated the incidence of new-onset POAF (within 48 hours after surgery) before and after propensity score matching. RESULTS Of the 482 patients, 344 received propofol, and 138 received desflurane during anesthetic maintenance. The incidence of POAF in the propofol group was less than that in the desflurane group (4 [1.2%] vs. 8 patients [5.8%], odds ratio [OR]; 0.161, 95% confidence interval (CI), 0.040-0.653, p = 0.011) in the present study population. After adjustment for propensity score matching (n = 254, n = 127 each group), the incidence of POAF was still less in propofol group than desflurane group (1 [0.8%] vs. 8 patients [6.3%], OR; 0.068, 95% CI: 0.007-0.626, p = 0.018). CONCLUSIONS These retrospective data suggest propofol anesthesia significantly inhibits POAF compared to desflurane anesthesia in patients undergoing VATS. Further prospective studies are needed to elucidate the mechanism of propofol on the inhibition of POAF.
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Affiliation(s)
- Karin Tajima
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Yamakawa
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Kuwabara
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Chika Miyazaki
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Sunaga
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoichi Uezono
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
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Hypnotic communication during atrial fibrillation ablation: Another clinical application of hypnotherapy? IJC HEART & VASCULATURE 2019; 24:100408. [PMID: 31453313 PMCID: PMC6700424 DOI: 10.1016/j.ijcha.2019.100408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 01/05/2023]
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Yildiz M, Yilmaz Ak H, Oksen D, Oral S. Anesthetic Management In Electrophysiology Laboratory: A Multidisciplinary Review. J Atr Fibrillation 2018; 10:1775. [PMID: 29988243 DOI: 10.4022/jafib.1775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/19/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022]
Abstract
Many clinical challenges have been encountered in electrophysiology laboratories (EP) while implanting intracardiac defibrillators for lethal arrhythmias, using pacemakers for bradyarrhythmias, placing pacemakers with multiple leads in patients with heart failure and cardiac ablation procedures. In this environment, anesthesiology plays a very critical role to ensure patients comfort, as well as maintains operator's convenience and facilitate management of undesired situations. EP laboratories are mostly used for diagnosis of certain heart diseases. Meanwhile, with the exponential increase in interventional procedures in our decade, electrophysiologists' need to cooperate with the anesthesiologists more frequently. The literature is still unclear about the effects of anesthetic agents on cardiac conduction pathways, but as we know with our previous data, the most agents we are using currently have more or less effect on the cardiac conduction systems. In this review, we aimed to describe the safe anesthesia methods in cardiac diagnostic procedures and have a closer look up the anesthetic outcomes of these procedures. This article comprehensively reviews the anesthesia practice encountered in electrophysiology laboratories.
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Affiliation(s)
| | - Hulya Yilmaz Ak
- Anesthesiology and Reanimation, Istanbul University Cardiology Institute, Istanbul, Turkey
| | | | - Sinan Oral
- Independent Investigator, Istanbul, Turkey
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Montero-Tinnirello J, Magaldi M, Fontanals J, Masgoret P, Bravo JC. Sinusal reversion of supraventricular tachyarrhythmias after propofol administration. A case series. Med Intensiva 2016; 41:499-501. [PMID: 28027785 DOI: 10.1016/j.medin.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 11/19/2022]
Affiliation(s)
- J Montero-Tinnirello
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España.
| | - M Magaldi
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España
| | - J Fontanals
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España
| | - P Masgoret
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España
| | - J C Bravo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic, Barcelona, España
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Kojima A, Bai JY, Ito Y, Ding WG, Kitagawa H, Matsuura H. Serum albumin attenuates the open-channel blocking effects of propofol on the human Kv1.5 channel. Eur J Pharmacol 2016; 783:117-26. [DOI: 10.1016/j.ejphar.2016.04.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 11/29/2022]
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Ichihara N, Miyazaki S, Taniguchi H, Usui E, Takagi T, Iwasawa J, Kuroi A, Nakamura H, Hachiya H, Iesaka Y. Simple Minimal Sedation for Catheter Ablation of Atrial Fibrillation. Circ J 2015; 79:346-50. [DOI: 10.1253/circj.cj-14-1106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Eisuke Usui
- Cardiovascular Center, Tsuchiura Kyodo Hospital
| | | | - Jin Iwasawa
- Cardiovascular Center, Tsuchiura Kyodo Hospital
| | - Akio Kuroi
- Cardiovascular Center, Tsuchiura Kyodo Hospital
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Decloedt A, de Clercq D, van der Vekens N, Verheyen T, Ven S, van Loon G. Influence of detomidine on atrial fibrillation cycle length measured by intracardiac electrogram recording and by colour tissue Doppler imaging in horses. Equine Vet J 2014; 48:21-6. [DOI: 10.1111/evj.12366] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 09/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Decloedt
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - D. de Clercq
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - N. van der Vekens
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - T. Verheyen
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - S. Ven
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
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MOUNTANTONAKIS STAVROSE, ELKASSABANY NABIL, KONDAPALLI LAVANYA, MARCHLINSKI FRANCISE, MANDEL JEFFE, HUTCHINSON MATHEWD. Provocation of Atrial Fibrillation Triggers During Ablation: Does the Use of General Anesthesia Affect Inducibility? J Cardiovasc Electrophysiol 2014; 26:16-20. [DOI: 10.1111/jce.12512] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/28/2014] [Accepted: 07/31/2014] [Indexed: 12/18/2022]
Affiliation(s)
| | - NABIL ELKASSABANY
- Department of Anesthesiology and Critical Care; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - LAVANYA KONDAPALLI
- Cardiovascular Division; Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - FRANCIS E. MARCHLINSKI
- Cardiovascular Division; Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - JEFF E. MANDEL
- Department of Anesthesiology and Critical Care; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - MATHEW D. HUTCHINSON
- Cardiovascular Division; Department of Medicine; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
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