Anesthesia care for subcutaneous implantable cardioverter/defibrillator placement: a single-center experience

Anesthesia for subcutaneous implantable cardioverter‐defibrillator implantation: Perspectives from the clinical experience of a U.S. panel of physicians

“…Drawbacks associated with GA usage for S‐ICD implantation may include the following: limited availability of anesthesia services, hemodynamic instability, airway injury, postintubation pneumonia, longer procedure room utilization time, additional time for patient evaluation by the anesthesiologist, longer post‐GA recovery time, the need for skilled postanesthesia care nurses for recovery, and increased overall cost . Although many anesthesiologists may deem it safer to have a secured airway for S‐ICD implantation and DT, the myocardial depressant and vasodilatory properties of volatile anesthetics coupled with adverse hemodynamics associated with DT should be considered when deciding upon anesthetic type .…”

“…With MAC, there is the possibility of oversedation and transition to GA without a secured airway, which in turn may lead to increased morbidity and mortality . Common MAC sedatives/analgesics, and anesthetics such as benzodiazepines, opioids, and propofol, have been shown to increase respiratory complications and may also cause hypotension . Therefore, the use of MAC may be associated with unanticipated airway obstruction and the need for airway support maneuvers, such as the jaw thrust maneuver and/or airway intervention (nasopharyngeal airway, oropharyngeal airway, bag‐mask ventilation, laryngeal mask airway insertion, and/or endotracheal intubation) …”

“…The main concern for NASA is patient safety, due to the risk of respiratory and cardiovascular complications associated with sedation . This risk is especially high when nonanesthesia personnel administer potent sedatives/analgesics, and anesthetics with narrow therapeutic windows, i.e., unintentional rapid transition from sedation to GA . Propofol especially causes hypotension, bradycardia, central and peripheral apnea, and blunts airway reflexes, and should be administered with extra caution if at all .…”

“…The nurse responsible for patient sedation and monitoring should be exempt from additional duties, in order to enable rapid recognition and treatment of sedation‐related complications . In the event of an airway complication, personnel with significant training and experience in advanced airway management should be readily available to provide care and prevent adverse outcomes …”

“… Anesthesia and sedation plan need to be customized to the patient. Use of a dedicated anesthesia team during the S‐ICD implant‐learning curve phase (initial 5–10 implants). GA can be utilized, but is not required for S‐ICD implants. The preferred technique for cases with anesthesia support may be MAC. If an implanter plans to use the NASA approach for S‐ICD implants, it is suggested to work with an anesthesiologist for several cases before performing NASA without anesthesia involvement. Know your hospital guidelines regarding: (1) NASA, (2) use of nonanesthesia professionals to monitor patients under moderate‐to‐deep sedation, and (3) requirements for deep sedation privileges Excellent local anesthesia is critical to patient comfort. Establish a NASA protocol for S‐ICD procedures using dedicated meetings involving electrophysiologists and anesthesiologists as well as electrophysiology laboratory staff to help clarify and assure proper workflow and equipment and adequate training for all team members …”