Deep Sedation for Catheter Ablation of Atrial Fibrillation: A Prospective Study in 650 Consecutive Patients
Deep Sedation for Catheter Ablation of AF. Introduction: Catheter ablation of atrial fibrillation (AF) is a highly invasive and relatively long‐lasting procedure with specific requirements for patient sedation. The feasibility and safety of deep sedation is described in a prospective study of 650 co...
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| Published in | Journal of cardiovascular electrophysiology Vol. 22; no. 12; pp. 1339 - 1343 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Malden, USA
Blackwell Publishing Inc
01.12.2011
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Deep Sedation for Catheter Ablation of AF. Introduction: Catheter ablation of atrial fibrillation (AF) is a highly invasive and relatively long‐lasting procedure with specific requirements for patient sedation. The feasibility and safety of deep sedation is described in a prospective study of 650 consecutive patients.
Methods:
Sedation was initiated with an intravenous (iv) bolus of midazolam, and analgesia with an iv fentanyl bolus. After an iv propofol bolus, maintenance of sedation was achieved with continuous iv administration of propofol with a guide dose of 5 mg per kg per hour. Heart rate, invasive arterial blood pressure, and oxygenation were continuously monitored. The administration of sedation and analgesia medication were performed by a nurse under the supervision and instructions of the electrophysiologist.
Results:
The mean dose of the initial midazolam bolus was 2.4 ± 0.7 mg and of the initial propofol bolus 32 ± 11 mg. The beginning dose of continuous propofol infusion was 352 ± 66 mg/h; titration to the desired effect of deep sedation required adjustment on an average of 3.8 ± 2.6 times leading to a maintenance dose of continuous propofol infusion of 399 ± 99 mg/h. No major sedation‐related complications were observed. Endotracheal intubation was necessary in none of the patients. Heart rate, invasive arterial blood pressure, and oxygenation remained stable during sedation.
Conclusion:
Deep sedation for catheter ablation of AF is feasible and safe. Especially, the goal of keeping the patient in deep sedation while maintaining spontaneous ventilation and cardiovascular hemodynamic stability was accomplished. Endotracheal intubation or consultation of an anesthesiologist was not necessary in any patient. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1339‐1343, December 2011) |
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| AbstractList | Catheter ablation of atrial fibrillation (AF) is a highly invasive and relatively long-lasting procedure with specific requirements for patient sedation. The feasibility and safety of deep sedation is described in a prospective study of 650 consecutive patients.
Sedation was initiated with an intravenous (iv) bolus of midazolam, and analgesia with an iv fentanyl bolus. After an iv propofol bolus, maintenance of sedation was achieved with continuous iv administration of propofol with a guide dose of 5 mg per kg per hour. Heart rate, invasive arterial blood pressure, and oxygenation were continuously monitored. The administration of sedation and analgesia medication were performed by a nurse under the supervision and instructions of the electrophysiologist.
The mean dose of the initial midazolam bolus was 2.4 ± 0.7 mg and of the initial propofol bolus 32 ± 11 mg. The beginning dose of continuous propofol infusion was 352 ± 66 mg/h; titration to the desired effect of deep sedation required adjustment on an average of 3.8 ± 2.6 times leading to a maintenance dose of continuous propofol infusion of 399 ± 99 mg/h. No major sedation-related complications were observed. Endotracheal intubation was necessary in none of the patients. Heart rate, invasive arterial blood pressure, and oxygenation remained stable during sedation.
Deep sedation for catheter ablation of AF is feasible and safe. Especially, the goal of keeping the patient in deep sedation while maintaining spontaneous ventilation and cardiovascular hemodynamic stability was accomplished. Endotracheal intubation or consultation of an anesthesiologist was not necessary in any patient. INTRODUCTIONCatheter ablation of atrial fibrillation (AF) is a highly invasive and relatively long-lasting procedure with specific requirements for patient sedation. The feasibility and safety of deep sedation is described in a prospective study of 650 consecutive patients.METHODSSedation was initiated with an intravenous (iv) bolus of midazolam, and analgesia with an iv fentanyl bolus. After an iv propofol bolus, maintenance of sedation was achieved with continuous iv administration of propofol with a guide dose of 5 mg per kg per hour. Heart rate, invasive arterial blood pressure, and oxygenation were continuously monitored. The administration of sedation and analgesia medication were performed by a nurse under the supervision and instructions of the electrophysiologist.RESULTSThe mean dose of the initial midazolam bolus was 2.4 ± 0.7 mg and of the initial propofol bolus 32 ± 11 mg. The beginning dose of continuous propofol infusion was 352 ± 66 mg/h; titration to the desired effect of deep sedation required adjustment on an average of 3.8 ± 2.6 times leading to a maintenance dose of continuous propofol infusion of 399 ± 99 mg/h. No major sedation-related complications were observed. Endotracheal intubation was necessary in none of the patients. Heart rate, invasive arterial blood pressure, and oxygenation remained stable during sedation.CONCLUSIONDeep sedation for catheter ablation of AF is feasible and safe. Especially, the goal of keeping the patient in deep sedation while maintaining spontaneous ventilation and cardiovascular hemodynamic stability was accomplished. Endotracheal intubation or consultation of an anesthesiologist was not necessary in any patient. Deep Sedation for Catheter Ablation of AF. Introduction: Catheter ablation of atrial fibrillation (AF) is a highly invasive and relatively long‐lasting procedure with specific requirements for patient sedation. The feasibility and safety of deep sedation is described in a prospective study of 650 consecutive patients. Methods: Sedation was initiated with an intravenous (iv) bolus of midazolam, and analgesia with an iv fentanyl bolus. After an iv propofol bolus, maintenance of sedation was achieved with continuous iv administration of propofol with a guide dose of 5 mg per kg per hour. Heart rate, invasive arterial blood pressure, and oxygenation were continuously monitored. The administration of sedation and analgesia medication were performed by a nurse under the supervision and instructions of the electrophysiologist. Results: The mean dose of the initial midazolam bolus was 2.4 ± 0.7 mg and of the initial propofol bolus 32 ± 11 mg. The beginning dose of continuous propofol infusion was 352 ± 66 mg/h; titration to the desired effect of deep sedation required adjustment on an average of 3.8 ± 2.6 times leading to a maintenance dose of continuous propofol infusion of 399 ± 99 mg/h. No major sedation‐related complications were observed. Endotracheal intubation was necessary in none of the patients. Heart rate, invasive arterial blood pressure, and oxygenation remained stable during sedation. Conclusion: Deep sedation for catheter ablation of AF is feasible and safe. Especially, the goal of keeping the patient in deep sedation while maintaining spontaneous ventilation and cardiovascular hemodynamic stability was accomplished. Endotracheal intubation or consultation of an anesthesiologist was not necessary in any patient. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1339‐1343, December 2011) |
| Author | HINDRICKS, GERHARD MÜLLER, KRISTIN SIEDZIAKO, ANGELA KOTTKAMP, HANS EITEL, CHARLOTTE VAROUNIS, CHRISTOS SOMMER, PHILIPP ANASTASIOU-NANA, MARIA PIORKOWSKI, CHRISTOPHER ARYA, ARASH KOCH, JULIA GASPAR, THOMAS DAGRES, NIKOLAOS |
| Author_xml | – sequence: 1 givenname: HANS surname: KOTTKAMP fullname: KOTTKAMP, HANS organization: Department of Electrophysiology, Clinic Hirslanden, Zurich, Switzerland – sequence: 2 givenname: GERHARD surname: HINDRICKS fullname: HINDRICKS, GERHARD organization: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany – sequence: 3 givenname: CHARLOTTE surname: EITEL fullname: EITEL, CHARLOTTE organization: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany – sequence: 4 givenname: KRISTIN surname: MÜLLER fullname: MÜLLER, KRISTIN organization: Department of Electrophysiology, Clinic Hirslanden, Zurich, Switzerland – sequence: 5 givenname: ANGELA surname: SIEDZIAKO fullname: SIEDZIAKO, ANGELA organization: Department of Electrophysiology, Clinic Hirslanden, Zurich, Switzerland – sequence: 6 givenname: JULIA surname: KOCH fullname: KOCH, JULIA organization: Department of Electrophysiology, Clinic Hirslanden, Zurich, Switzerland – sequence: 7 givenname: MARIA surname: ANASTASIOU-NANA fullname: ANASTASIOU-NANA, MARIA organization: 2nd Department of Cardiology, University of Athens, Attikon University Hospital, Athens, Greece – sequence: 8 givenname: CHRISTOS surname: VAROUNIS fullname: VAROUNIS, CHRISTOS organization: 2nd Department of Cardiology, University of Athens, Attikon University Hospital, Athens, Greece – sequence: 9 givenname: ARASH surname: ARYA fullname: ARYA, ARASH organization: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany – sequence: 10 givenname: PHILIPP surname: SOMMER fullname: SOMMER, PHILIPP organization: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany – sequence: 11 givenname: THOMAS surname: GASPAR fullname: GASPAR, THOMAS organization: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany – sequence: 12 givenname: CHRISTOPHER surname: PIORKOWSKI fullname: PIORKOWSKI, CHRISTOPHER organization: Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany – sequence: 13 givenname: NIKOLAOS surname: DAGRES fullname: DAGRES, NIKOLAOS organization: 2nd Department of Cardiology, University of Athens, Attikon University Hospital, Athens, Greece |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/21692895$$D View this record in MEDLINE/PubMed |
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| Title | Deep Sedation for Catheter Ablation of Atrial Fibrillation: A Prospective Study in 650 Consecutive Patients |
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