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Rajagopalan B, Lakkireddy D, Al-Ahmad A, Chrispin J, Cohen M, Di Biase L, Gopinathannair R, Nasr V, Navara R, Patel P, Santangeli P, Shah R, Sotomonte J, Sridhar A, Tzou W, Cheung JW. Management of anesthesia for procedures in the cardiac electrophysiology laboratory. Heart Rhythm 2024:S1547-5271(24)02822-4. [PMID: 38942104 DOI: 10.1016/j.hrthm.2024.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/16/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
The complexity of cardiac electrophysiology procedures has increased significantly during the past 3 decades. Anesthesia requirements of these procedures can differ on the basis of patient- and procedure-specific factors. This manuscript outlines various anesthesia strategies for cardiac implantable electronic devices and electrophysiology procedures, including preprocedural, procedural, and postprocedural management. A team-based approach with collaboration between cardiac electrophysiologists and anesthesiologists is required with careful preprocedural and intraprocedural planning. Given the recent advances in electrophysiology, there is a need for specialized cardiac electrophysiology anesthesia care to improve the efficacy and safety of the procedures.
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Affiliation(s)
| | | | | | - Jonathan Chrispin
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mitchell Cohen
- Division of Cardiology, Inova Children's Hospital, Fairfax, Virginia
| | - Luigi Di Biase
- Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | | | - Viviane Nasr
- Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts
| | - Rachita Navara
- Department of Medicine, University of California, San Francisco, California
| | - Parin Patel
- Ascension St Vincent's Hospital, Indianapolis, Indiana
| | | | - Ronak Shah
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Wendy Tzou
- Department of Medicine, University of Colorado, Denver, Colorado
| | - Jim W Cheung
- Department of Medicine, Weill Cornell Medicine/NewYork-Presbyterian, New York, New York
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2
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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.
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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
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Bock M, O’Connor M, Chouchane A, Schmidt P, Schaarschmidt C, Knoll K, Bahlke F, Englert F, Storz T, Kottmaier M, Trenkwalder T, Reents T, Bourier F, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Kolb C, Lennerz C. Cardiologist-Directed Sedation Management in Patients Undergoing Transvenous Lead Extraction: A Single-Centre Retrospective Analysis. J Clin Med 2023; 12:4900. [PMID: 37568301 PMCID: PMC10420171 DOI: 10.3390/jcm12154900] [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: 05/18/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The demand for transvenous lead extraction (TLE) has increased. In line with this, the safety of such procedures has also increased. Traditionally, TLE is performed under resource-intensive general anaesthesia. This study aims to evaluate the safety and outcomes of Cardiologist-lead deep sedation for TLE. METHODS We retrospectively analysed 328 TLE procedures performed under deep sedation from 2016 to 2019. TLE procedures were performed by experienced electrophysiologists. Sedation was administered by a specifically trained cardiologist (bolus midazolam/fentanyl and propofol infusion). Procedural sedation data including blood pressure, medication administration and sedation time were collected. Complications related to sedation and the operative component of the procedure were analysed retrospectively. RESULTS The sedation-associated complication rate during TLE was 22.0%. The most common complication (75% of complications) was hypotension requiring noradrenaline, followed by bradycardia requiring atropine (13% of complications). Additionally, the unplanned presence of an anaesthesiologist was needed in one case (0.3%). Deep sedation was achieved with midazolam (mean dose 42.9 ± 26.5 µg/kg), fentanyl (mean dose 0.4 ± 0.6 µg/kg) and propofol (mean dose 3.5 ± 1.2 mg/kg/h). There was no difference in medication dosage between those with a sedation-associated complication and those without. Sedation-associated complications appeared significantly more in patients with reduced LVEF (p = 0.01), renal impairment (p = 0.01) and a higher American Society of Anaesthesiologists (ASA) class (p = 0.01). CONCLUSION Deep sedation for TLE can be safely performed by a specifically trained cardiologist, with a transition to general anaesthesia required in only 0.3% of cases. We continue to recommend the on-call availability of an anaesthesiologist and cardiac surgeon in case of major complications.
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Affiliation(s)
- Matthias Bock
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
| | - Matthew O’Connor
- Auckland City Hospital, Department of Cardiology, Auckland 1023, New Zealand
| | - Amir Chouchane
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Philip Schmidt
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Claudia Schaarschmidt
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Katharina Knoll
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
| | - Fabian Bahlke
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Florian Englert
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Theresa Storz
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Marc Kottmaier
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Teresa Trenkwalder
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Tilko Reents
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Felix Bourier
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Marta Telishevska
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Sarah Lengauer
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Gabriele Hessling
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Isabel Deisenhofer
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Christof Kolb
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
| | - Carsten Lennerz
- German Heart Centre Munich, Department of Electrophysiology, Technical University of Munich, 80636 Munich, Germany (C.K.)
- DZHK (German Centre for Cardiovascular Research, Partner Site Munich, Heart Alliance), 80336 Munich, Germany
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The importance of anaesthesia in atrial fibrillation ablation: Comparing conscious sedation with general anaesthesia. Indian Pacing Electrophysiol J 2023; 23:47-52. [PMID: 36509310 PMCID: PMC10014632 DOI: 10.1016/j.ipej.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND General anaesthesia (GA) for atrial fibrillation (AF) ablation is often preferred over conscious sedation (CS) to minimize patient discomfort and reduce the risk of map disruption from patient movement but may pose an additional risk to some patients with significant comorbidity or poor cardiac function. METHODS We extracted data for 300 patients who underwent AF ablation between the years 2017 and 2019 and compared the outcomes of AF ablation with CS and GA. RESULTS Compared to the GA group, patients were younger in the CS group (63 versus 66 years, p = 0.02), had less persistent AF (34% versus 46%, p = 0.048) and the left atrial dimension was smaller (41 versus 45 mm, p = 0.01). More patients had cryoballoon ablation (CBA) than radiofrequency (RFA) ablation in the CS than the GA group (88% CB with CS and 56% RF with GA, p < 0.01), frequency of ASA score 3-4 (higher anaesthetic risk) was less for CS than for GA (45% versus 75%, p < 0.01), and procedural duration was shorter for patients who had CS (110 versus 139 min, p < 0.001). Of the patients receiving CS, 127/182 (70%) were planned for same day discharge (SDD) and this occurred in 120 (94%) of those patients. There were no significant differences in complication rates between the groups (5.1% in GA and 6% in CS, p = 0.8). AF type was the only significant predictor of freedom from AF recurrence on multivariate analysis (HR 0.33, 0.13-0.82, p = 0.018). CONCLUSION In this study, the use of CS compared with GA for AF ablation was associated with similar outcomes and complication rates.
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Bode K, Gerhards M, Doering M, Lucas J, Tijssen J, Dagres N, Hilbert S, Richter S, Nedios S, Lurz J, Moscoso-Luduena C, Arya A, Shamloo AS, Hindricks G. A randomized trial of non-fasting vs. fasting for cardiac implantable electronic device procedures (Fast-CIED Study). Europace 2022; 24:1617-1626. [PMID: 35726877 DOI: 10.1093/europace/euac081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Data on safety and efficacy of a non-fasting strategy in minimal invasive cardiac procedures are lacking. We assessed a non-fasting strategy compared with a fasting strategy regarding patient's well-being and safety in elective cardiac implantable electronic device (CIED) procedures. METHODS AND RESULTS In this randomized, single-blinded clinical trial, 201 patients (non-fasting = 100, fasting = 101) with a mean age of 72.0 ± 11.6 years (66.7% male) were assigned to a non-fasting strategy (solids/fluids allowed up to 1 h) or a fasting strategy (at least 6 h no solids and 2 h no fluids) before the procedure and analysed on an intention-to-treat basis. The co-primary outcomes were patients' well-being scores (based on numeric rating scale, 0-10) and incidence of intra-procedural food-related adverse events, including vomiting, perioperative pulmonary aspiration, and emergency intubation. Renal, haematological, and metabolic blood parameters and 30-day follow-up data were gathered. The summed pre-procedural patients' well-being score was significantly lower in the non-fasting group [non-fasting: 13.1 ± 9.6 vs. fasting: 16.5 ± 11.4, 95% confidence interval (CI) of mean difference (MD) -6.35 to -0.46, P = 0.029], which was mainly driven by significantly lower scores for hunger and tiredness in the non-fasting group (non-fasting vs. fasting; hunger: 0.9 ± 1.9 vs. 3.1 ± 3.2, 95% CI of MD -2.86 to -1.42, P < 0.001; tiredness: 1.6 ± 2.3 vs. 2.6 ± 2.7, 95% CI of MD -1.68 to -0.29, P = 0.023). No intra-procedural food-related adverse events were observed. Relevant blood parameters and 30-day follow-up did not show significant differences. CONCLUSION These results showed that a non-fasting strategy is beneficial to a fasting one regarding patient's well-being and comparable in terms of safety for CIED procedures (NCT04389697).
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Affiliation(s)
- Kerstin Bode
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany.,Department of Cardiology, Asklepios Clinic Weißenfels, Weißenfels, Germany
| | - Matthias Gerhards
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Johannes Lucas
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Julia Lurz
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Cathleen Moscoso-Luduena
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
| | - Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Naumburger Str. 76, 04443 Weißenfels, Germany
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Sanders DJ, Wasserlauf J. Holding Still for AF Ablation. J Cardiovasc Electrophysiol 2022; 33:1723-1724. [PMID: 35652825 DOI: 10.1111/jce.15584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
Appropriate procedural sedation is imperative to successful catheter ablation (CA) for atrial fibrillation (AF). This article is protected by copyright. All rights reserved.
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Affiliation(s)
- David J Sanders
- Division of Cardiology, Section of Electrophysiology, Rush University
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7
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Yokokawa M, Chugh A, Dubovoy A, Engoren M, Jongnarangsin K, Latchamsetty R, Ghanbari H, Saeed M, Cunnane R, Crawford T, Ghannam M, Liang J, Keast R, Karpenko D, Bogun F, Pelosi F, Dubovoy T, Caldwell M, Morady F, Oral H. A Comparison of Clinical Outcomes and Cost of Radiofrequency Catheter Ablation for Atrial Fibrillation with Monitored Anesthesia Care vs General Anesthesia. J Cardiovasc Electrophysiol 2022; 33:1714-1722. [PMID: 35652836 PMCID: PMC9541425 DOI: 10.1111/jce.15582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/27/2022] [Accepted: 05/07/2022] [Indexed: 12/01/2022]
Abstract
Introduction Monitored anesthesia care (MAC) or general anesthesia (GA) can be used during catheter ablation (CA) of atrial fibrillation (AF). However, each approach may have advantages and disadvantages with variability in operator preferences. The optimal approach has not been well established. The purpose of this study was to compare procedural efficacy, safety, clinical outcomes, and cost of CA for AF performed with MAC versus GA. Methods The study population consisted of 810 consecutive patients (mean age: 63 ± 10 years, paroxysmal AF: 48%) who underwent a first CA for AF. All patients completed a preprocedural evaluation by the anesthesiologists. Among the 810 patients, MAC was used in 534 (66%) and GA in 276 (34%). Ten patients (1.5%) had to convert to GA during the CA. Results Although the total anesthesia care was longer with GA particularly in patients with persistent AF, CA was shorter by 5 min with GA than MAC (p < 0.01). Prevalence of perioperative complications was similar between the two groups (4% vs. 4%, p = 0.89). There was no atrioesophageal fistula with either approach. GA was associated with a small, ~7% increase in total charges due to longer anesthesia care. During 43 ± 17 months of follow‐up after a single ablation procedure, 271/534 patients (51%) in the MAC and 129/276 (47%) patients in the GA groups were in sinus rhythm without concomitant antiarrhythmic drug therapy (p = 0.28). Conclusion With the participation of an anesthesiologist, and proper preoperative assessment, CA of AF using GA or MAC has similar efficacy and safety.
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Affiliation(s)
- Miki Yokokawa
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Aman Chugh
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Anna Dubovoy
- Cardiac Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Milo Engoren
- Cardiac Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Hamid Ghanbari
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Mohammed Saeed
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Ryan Cunnane
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Thomas Crawford
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Michael Ghannam
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Jackson Liang
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Robert Keast
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - David Karpenko
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Frank Bogun
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Frank Pelosi
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Timur Dubovoy
- Cardiac Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Mathew Caldwell
- Cardiac Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Fred Morady
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Hakan Oral
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
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8
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Deep sedation with propofol in patients undergoing left atrial ablation procedures - is it safe? Heart Rhythm O2 2022; 3:288-294. [PMID: 35734291 PMCID: PMC9207726 DOI: 10.1016/j.hroo.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Catheter ablation for atrial fibrillation (AF) or left atrial tachycardia is well established. To avoid body movement and pain, sedative and analgesic agents are used. Objective The aim was to investigate safety of sedation/anti-pain protocol administered by electrophysiology (EP) staff. Methods A total of 3211 consecutive patients (61% male) undergoing left atrial ablation for paroxysmal AF (37.1%), persistent AF (35.3%) or left atrial tachycardia (27.6%) were included. Midazolam, fentanyl, and propofol were administered by EP staff. In case of respiratory depression, endotracheal intubation (eIT) or noninvasive ventilation (NIV) was implemented. Risk factors for eIT or NIV were analyzed. Results Mean doses of propofol, midazolam, and fentanyl were 33.7 ± 16.7 mg, 3 ± 11.1 mg, and 0.16 ± 2.2 mg, respectively. Norepinephrine was administered in 396 of 3211 patients (12.3%) because of blood pressure drop (mean arterial pressure <60 mm Hg). NIV was necessary in 47 patients (1.5%) and eIT in 1 patient (0.03%). Procedure duration, high body mass index (BMI), high CHADS2-VASC2 score, high age, low glomerular filtration rate, diabetes mellitus, and low baseline oxygen saturation were associated with NIV or eIT. The only independent predictor for NIV/eIT was high BMI (>30.1 ± 9.0 kg/m2). Therefore, patients with a BMI of ≥30 had a 40% higher risk for the need of NIV/eIT during the procedure in our study. Conclusion Sedation/anti-pain control including midazolam, propofol, and fentanyl administered by EP staff is safe, with only 1.53% requirement of NIV/eIT. High BMI (>30 kg/m2) emerged as an independent predictor for eIT/NIV.
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9
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Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization. J Interv Cardiol 2021; 2021:9932171. [PMID: 34404983 PMCID: PMC8355996 DOI: 10.1155/2021/9932171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022] Open
Abstract
Objective We aimed to study the differences in perception of pain during cardiac catheterization with midazolam monotherapy compared to the current standard of midazolam plus fentanyl. Background Procedural sedation is important to ensure comfort and safety in patients undergoing left heart catheterization. Despite the widespread use of midazolam and fentanyl for procedural sedation, the effectiveness of this dual agent approach to sedation has never been studied in comparison to midazolam monotherapy. Methods A total of 129 patients undergoing sedation for outpatient elective cardiac catheterization were randomly assigned to either midazolam monotherapy (n = 69) or combination of midazolam and fentanyl (n = 60). The primary outcome was assessment of pain perception prior to discharge by patient completion of a pain questionnaire. Participants were asked if they experienced any pain during their procedure (yes/no) and, if yes, asked to rate their overall pain level using a 10-point Likert scale that ranged from 1 (minimal pain) to 10 (worst pain imaginable). Results Most patients (n = 94, 73%) reported no pain during their procedure. Patients sedated with midazolam monotherapy reported similar average pain scores compared to patients sedated with the combination of midazolam and fentanyl (1.1 vs. 1.1, p=0.95). Conclusions Among patients undergoing elective cardiac catheterization, no significant differences in pain scores were noted between sedation with midazolam alone compared to midazolam and fentanyl. Due to fentanyl's unfavorable interaction with P2Y12 agents, increased costs, and addiction potential, it is imperative that cardiologists revisit the role of effective procedural sedation with a single agent and avoid the use of fentanyl.
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10
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Weinmann K, Heudorfer R, Lenz A, Aktolga D, Rattka M, Bothner C, Pott A, Öchsner W, Rottbauer W, Dahme T. Safety of conscious sedation in electroanatomical mapping procedures and cryoballoon pulmonary vein isolation. Heart Vessels 2020; 36:561-567. [PMID: 33211151 PMCID: PMC7940268 DOI: 10.1007/s00380-020-01725-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
Immobilization of patients during electrophysiological procedures, to avoid complications by patients' unexpected bodily motion, is achieved by moderate to deep conscious sedation using benzodiazepines and propofol for sedation and opioids for analgesia. Our aim was to compare respiratory and hemodynamic safety endpoints of cryoballoon pulmonary vein isolation (PVI) and electroanatomical mapping (EAM) procedures. Included patients underwent either cryoballoon PVI or EAM procedures. Sedation monitoring included non-invasive blood pressure measurements, transcutaneous oxygen saturation (tSpO2) and transcutaneous carbon-dioxide (tpCO2) measurements. We enrolled 125 consecutive patients, 67 patients underwent cryoballoon atrial fibrillation ablation and 58 patients had an EAM and radiofrequency ablation procedure. Mean procedure duration of EAM procedures was significantly longer (p < 0.001) and propofol doses as well as morphine equivalent doses of administered opioids were significantly higher in EAM patients compared to cryoballoon patients (p < 0.001). Cryoballoon patients display higher tpCO2 levels compared to EAM patients at 30 min (cryoballoon: 51.1 ± 7.0 mmHg vs. EAM: 48.6 ± 6.2 mmHg, p = 0.009) and at 60 min (cryoballoon: 51.4 ± 7.3 mmHg vs. EAM: 48.9 ± 6.6 mmHg, p = 0.07) procedure duration. Mean arterial pressure was significantly higher after 60 min (cryoballoon: 84.7 ± 16.7 mmHg vs. EAM: 76.7 ± 13.3 mmHg, p = 0.017) in cryoballoon PVI compared to EAM procedures. Regarding respiratory and hemodynamic safety endpoints, no significant difference was detected regarding hypercapnia, hypoxia and episodes of hypotension. Despite longer procedure duration and deeper sedation requirement, conscious sedation in EAM procedures appears to be as safe as conscious sedation in cryoballoon ablation procedures regarding hemodynamic and respiratory safety endpoints.
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Affiliation(s)
- Karolina Weinmann
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Regina Heudorfer
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Alexia Lenz
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Deniz Aktolga
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Manuel Rattka
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Carlo Bothner
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Alexander Pott
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Wolfgang Öchsner
- Department of Anesthesiology, Ulm University Medical Center, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany
| | - Tillman Dahme
- Department of Internal Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, Ulm, Germany.
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11
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Garcia R, Bouleti C, Li A, Frasca D, El Harrouchi S, Marechal J, Roumegou P, Corbi P, Christiaens L, Le Gal F, Degand B. Hypnosis Versus Placebo During Atrial Flutter Ablation: The PAINLESS Study: A Randomized Controlled Trial. JACC Clin Electrophysiol 2020; 6:1551-1560. [PMID: 33213815 DOI: 10.1016/j.jacep.2020.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study was to assess the superiority of hypnosis versus placebo on pain perception and morphine consumption during typical atrial flutter (AFL) ablation. BACKGROUND AFL ablation commonly requires intravenous opioid for analgesia, which can be associated with adverse outcomes. Hypnosis is an alternative technique with rising interest, but robust data in electrophysiological procedures are lacking. METHODS This single center, randomized controlled trial compared hypnosis and placebo during AFl ablation. In addition to the randomized intervention, all patients were treated according to the institution's standard of care analgesia protocol (administration of 1 mg of intravenous morphine in case of self-reported pain ≥5 on an 11-point numeric rating scale or on demand). The primary endpoint was perceived pain quantified by patients using a visual analog scale. RESULTS Between October 2017 and September 2019, 113 patients (mean age 70 ± 12 years, 21% women) were randomized to hypnosis (n = 56) or placebo (n = 57). Mean pain score was 4.0 ± 2.2 in the hypnosis group versus 5.5 ± 1.8 in the placebo group (p < 0.001). Pain perception, assessed every 5 min during the whole procedure, was consistently lower in the hypnosis group. Patients' sedation scores were also better in the hypnosis group than in the placebo group (8.3 ± 2.2 vs. 5.4 ± 2.5; p < 0.001). Finally, morphine requirements were significantly lower in the hypnosis group (1.3 ± 1.3 mg) compared with the placebo group (3.6 ± 1.8 mg; p < 0.001). CONCLUSIONS In this first randomized trial, hypnosis during AFL ablation was superior to placebo for alleviating pain and reducing morphine consumption.
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Affiliation(s)
- Rodrigue Garcia
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France; Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France.
| | - Claire Bouleti
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France; Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France; INSERM CIC 1402, Poitiers, France
| | - Anthony Li
- Cardiology Clinical Academic Group, St. George's University of London, London, United Kingdom
| | - Denis Frasca
- Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France; Centre Hopsitalier Universitaire (CHU) Poitiers, Anesthesia and Intensive Care, Poitiers, France
| | - Sophia El Harrouchi
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
| | - Julien Marechal
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
| | - Pierre Roumegou
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
| | - Pierre Corbi
- Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France; Centre Hospitalier Universitaire (CHU) Poitiers, Department of Thoracic and Cardiovascular Surgery, Poitiers, France
| | - Luc Christiaens
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France; Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France
| | - François Le Gal
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
| | - Bruno Degand
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
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Abstract
In a series of articles dealing with hypnotics for induction of anesthesia, this article describes the development and current value of propofol. Its significance far exceeds that of a pure induction hypnotic (sedation in diagnostic and therapeutic procedures and on the intensive care unit). Propofol is also used for sedation in diagnostic and therapeutic procedures and on the intensive care unit. In the field of induction of anesthesia, the alternatives are barely used. Some contraindications are still controversial whereas others are no longer sufficiently anchored in the users' awareness (widespread off-label use). Adverse effects, such as injection pain, infection risk and propofol-related infusion syndrome (PRIS) could be significantly reduced by pharmacovigilance. With appropriate caution nearly the whole spectrum of anesthesiology patients can be treated using propofol. The hemodynamic side effects and the rare but potentially fatal PRIS are limitations. Further developments address the water solubility and the solubilizing agents of propofol.
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Affiliation(s)
- D Bolkenius
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - C Dumps
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - E Halbeck
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
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13
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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
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14
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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.
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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
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15
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Diemberger I, Marazzi R, Casella M, Vassanelli F, Galimberti P, Luzi M, Borrelli A, Soldati E, Golzio PG, Fumagalli S, Francia P, Padeletti L, Botto G, Boriani G. The effects of gender on electrical therapies for the heart: procedural considerations, results and complications: A report from the XII Congress of the Italian Association on Arrhythmology and Cardiostimulation (AIAC). Europace 2018; 19:1911-1921. [PMID: 28520959 DOI: 10.1093/europace/eux034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/02/2017] [Indexed: 12/28/2022] Open
Abstract
Use of cardiac implantable devices and catheter ablation is steadily increasing in Western countries following the positive results of clinical trials. Despite the advances in scientific knowledge, tools development, and techniques improvement we still have some grey area in the field of electrical therapies for the heart. In particular, several reports highlighted differences both in medical behaviour and procedural outcomes between female and male candidates. Women are referred later for catheter ablation of supraventricular arrhythmias, especially atrial fibrillation, leading to suboptimal results. On the opposite females present greater response to cardiac resynchronization, while the benefit of implantable defibrillator in primary prevention seems to be less pronounced. Differences on aetiology, clinical profile, and development of myocardial scarring are the more plausible causes. This review will discuss all these aspects together with gender-related differences in terms of acute/late complications. We will also provide useful hints on plausible mechanisms and practical procedural aspects.
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Affiliation(s)
- Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Via Massarenti n. 9, 40138, Bologna, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesca Vassanelli
- Chair and Unit of Cardiology, University of Brescia, Spedali Civili Hospital, Brescia, Italy
| | - Paola Galimberti
- Electrophysiology and Pacing Unit, Humanitas Clinical and Research Center, Rozzano-Milano, Italy
| | - Mario Luzi
- Cardiology Clinic, Marche Polytechnic University, Ancona, Italy
| | | | - Ezio Soldati
- Cardiac Thoracic and Vascular Department, University Hospital of Pisa, Italy
| | - Pier Giorgio Golzio
- Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Stefano Fumagalli
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
| | - Pietro Francia
- Cardiac Electrophysiology Unit, Cardiology, St. Andrea Hospital, University "Sapienza", Rome, Italy
| | - Luigi Padeletti
- University of Florence, Florence, Italy IRCCS MultiMedica, Sesto San Giovanni, Italy
| | - Gianluca Botto
- EP Unit, Department of Medicine, Sant'Anna Hospital, Como, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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16
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Patton KK. Anesthesia and SICD implantation-When less (invasive) may be more. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:817-819. [PMID: 29718581 DOI: 10.1111/pace.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 04/21/2018] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kristen K Patton
- Division of Cardiology, University of Washington, Seattle, WA, USA
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17
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von Bary C, Laski V, Fricke H, Linhardt F, Reithmann C, Fiek M. Impact of intraoperative mechanical ventilation on left ventricular lead function in cardiac resynchronization therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:578-582. [PMID: 29577341 DOI: 10.1111/pace.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/04/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intraoperative controlled mechanical ventilation (CMV) changes the intrathoracic geometry and may impact postoperative left ventricular (LV) lead function after CRT implantation. This multicenter study investigates the effect of intraoperative ventilation setting (spontaneous breathing [SB] vs CMV) on postoperative LV lead function taking into account patients' body mass index (BMI). METHODS CRT implantation was performed at two centers during SB in 92 and during CMV in 73 patients. Follow-up was carried out after 3 ± 5 and 36 ± 53 days. Functional lead parameters (FLP; pacing threshold and impedance), postoperative adverse events (A; phrenic nerve stimulation [PNS] and lead malfunction), and patients' BMI were assessed. Delta values of FLP between baseline and follow-up visits were analyzed applying an analysis of covariance model to detect subclinical alterations in LV lead function. RESULTS AE occurred in a total of 36 (21%) patients. PNS was observed in 26 (15%) patients and LV lead repositioning due to malfunction was necessary in 10 (6%) patients. Both AE and FLP delta values between baseline and follow-up were not associated with intraoperative ventilation settings nor the patients' BMI. CONCLUSIONS This study demonstrates that there is no impact of the intraoperative ventilation setting (SB vs CMV) on postoperative FLP or the occurrence of AE. This is also the case taking into account the BMI. With respect to these findings both approaches-sedation only or general anaesthesia including CMV-can be safely implemented during CRT implantation.
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Affiliation(s)
- Christian von Bary
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Viktoria Laski
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Hannes Fricke
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Florian Linhardt
- Medizinische Klinik I, Rotkreuzklinikum München, Akademisches Lehrkrankenhaus der Technischen Universität München, München, Germany
| | - Christopher Reithmann
- Medizinische Klinik I, Helios Klinikum München West, Lehrkrankenhaus der Ludwig-Maximilans-Universität München, München, Germany
| | - Michael Fiek
- Medizinische Klinik I, Helios Klinikum München West, Lehrkrankenhaus der Ludwig-Maximilans-Universität München, München, Germany
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18
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Nørgaard MW, Pedersen PU, Bjerrum M. Understanding how patients use visualization during ablation of atrial fibrillation in reducing their experience of pain, anxiety, consumption of pain medication and procedure length: Integrating quantitative and qualitative results. Appl Nurs Res 2018; 39:229-240. [DOI: 10.1016/j.apnr.2017.11.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/19/2017] [Indexed: 11/26/2022]
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19
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Münkler P, Attanasio P, Parwani AS, Huemer M, Boldt LH, Haverkamp W, Wutzler A. High Patient Satisfaction with Deep Sedation for Catheter Ablation of Cardiac Arrhythmia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:585-590. [PMID: 28240366 DOI: 10.1111/pace.13063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 01/15/2017] [Accepted: 02/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients' satisfaction with invasive procedures largely relies on periprocedural perception of pain and discomfort. The necessity for intraprocedural sedation during catheter ablation of cardiac arrhythmias for technical reasons is widely accepted, but data on patients' experience of pain and satisfaction with the procedural sedation are scarce. We have assessed patients' pain and discomfort during and after the procedure using a standardized questionnaire. METHODS One hundred seventeen patients who underwent catheter ablation answered a standardized questionnaire on periprocedural perception of pain and discomfort after different anesthetic protocols with propofol/midazolam with and without additional piritramide and ketamine/midazolam. RESULTS Patients report a high level of satisfaction with periprocedural sedation with 83% judging sedation as good or very good. The majority of patients was unconscious of the whole procedure and did not recollect experiencing pain. Procedural pain was reported by 7.7% of the patients and 16% reported adverse effects, e.g., postprocedural nausea and episodes of headache. CONCLUSION The results of our study show that deep sedation during catheter ablation of cardiac arrhythmias is generally well tolerated and patients are satisfied with the procedure. Yet, a number of patients reports pain or adverse events. Therefore, studies comparing different sedation strategies should be conducted in order to optimize sedation and analgesia.
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Affiliation(s)
- Paula Münkler
- University Heart Center, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany
| | - Philipp Attanasio
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Abdul Shokor Parwani
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Alexander Wutzler
- Department of Electrophysiology and Cardiac Rhythm Management, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität, Bochum, Germany
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20
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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
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21
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Furniss SS, Sneyd JR. Safe sedation in modern cardiological practice. Heart 2015; 101:1526-30. [DOI: 10.1136/heartjnl-2015-307656] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/28/2015] [Indexed: 11/03/2022] Open
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22
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Conway A, Kennedy W, Sutherland J. Inadvertent Hypothermia After Procedural Sedation and Analgesia in a Cardiac Catheterization Laboratory: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2015; 29:1285-90. [PMID: 26384630 DOI: 10.1053/j.jvca.2015.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To identify the prevalence of and risk factors for inadvertent hypothermia after procedures performed with procedural sedation and analgesia in a cardiac catheterization laboratory. DESIGN A single-center, prospective observational study. SETTING A tertiary-care private hospital in Australia. PARTICIPANTS 399 patients undergoing elective procedures with procedural sedation and analgesia were included. Propofol infusions were used when an anesthesiologist was present. Otherwise, bolus doses of either midazolam or fentanyl or a combination of these medications was used. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS Hypothermia was defined as a temperature<36.0°C. Multivariate logistic regression was used to identify risk factors. Hypothermia was present after 23.3% (n = 93; 95% confidence interval [CI] 19.2%-27.4%) of 399 procedures. Sedative regimens with the highest prevalence of hypothermia were any regimen that included propofol (n = 35; 40.2%; 95% CI 29.9%-50.5%) and the use of fentanyl combined with midazolam (n = 23; 20.3%; 95% CI 12.9%-27.7%). Difference in mean temperature from pre-procedure to post-procedure was -0.27°C (standard deviation 0.45). Receiving propofol (odds ratio [OR] 4.6 95% CI 2.5-8.6), percutaneous coronary intervention (OR 3.2; 95% CI 1.7-5.9), body mass index<25 (OR 2.5; 95% CI 1.4-4.4) and being hypothermic prior to the procedure (OR 4.9; 95% CI 2.3-10.8) were independent predictors of post-procedural hypothermia. CONCLUSIONS A moderate prevalence of hypothermia was observed. The small absolute change in temperature observed may not be a clinically important amount. More research is needed to increase confidence in the authors' estimates of hypothermia in sedated patients and its impact on clinical outcomes.
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Affiliation(s)
- Aaron Conway
- Institute of Health and Biomedical Innovation, Queensland University Technology, Kelvin Grove, QLD, Australia.
| | - Wendy Kennedy
- Cardiac Catheter Laboratories, Princess Alexandra Hospital, Wooloongabba, QLD, Australia
| | - Joanna Sutherland
- Coffs Harbour Health Campus and Rural Clinical School, Coffs Harbour, NSW, Australia
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