Anesthesia and sedation strategies in electrophysiology: General concepts

Anjan Trikha, Bharathram Vasudevan, Anuradha Borle

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Numerous procedures are carried out in the cardiac electrophysiology laboratory including catheter ablation for various arrhythmias and implantation of devices such as pacemakers and implantable cardioverter-defibrillators (ICD). Patients undergoing these procedures pose unique challenges to the anesthetist as they have serious cardiovascular conditions like unstable arrhythmias, coronary artery disease and poor cardiac function, often with left ventricular ejection fraction less than 35 %. Many of these procedures can be carried out under local anesthesia with conscious sedation administered by a trained nurse. However, monitored anesthesia care with varying levels of sedation provided by trained anesthesia personnel is preferable in patients with multiple comorbidities and severe cardiac conditions. General anesthesia is needed for patient populations such as pediatric patients, those with poor functional status who cannot lie on their back and for complex catheter ablation procedures which require minimal patient movement for prolonged durations. Midazolam and fentanyl are the commonly used agents for conscious sedation. Propofol, etomidate or ketamine are commonly used for deeper sedation or general anesthesia. The effects of anesthetic drugs on the cardiac conduction system should be kept in mind as they can interfere with identifying arrhythmias during electrophysiological studies.

Original languageEnglish
Title of host publicationOut of Operating Room Anesthesia
Subtitle of host publicationA Comprehensive Review
PublisherSpringer International Publishing
Pages157-170
Number of pages14
ISBN (Electronic)9783319391502
ISBN (Print)9783319391489
DOIs
StatePublished - Sep 29 2016
Externally publishedYes

Keywords

  • Anesthesia
  • Atrial fibrillation
  • Cardiac electrophysiology
  • Cardiac resynchronization therapy
  • Catheter ablation
  • Etomidate
  • Fentanyl
  • High frequency jet ventilation
  • Implantable cardioverter-defibrillator
  • Ketamine
  • Midazolam
  • Monitored anesthesia care
  • Pacemaker
  • Propofol
  • Sedation

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  • Cite this

    Trikha, A., Vasudevan, B., & Borle, A. (2016). Anesthesia and sedation strategies in electrophysiology: General concepts. In Out of Operating Room Anesthesia: A Comprehensive Review (pp. 157-170). Springer International Publishing. https://doi.org/10.1007/978-3-319-39150-2_12