Deep sedation with propofol in patients undergoing left atrial ablation procedures—Is it safe?

Foerschner, Leonie; Harfoush, Nada; Thoma, Mara; Spitzbauer, Lovis; Popa, Miruna; Bourier, Félix; Reents, Tilko; Kantenwein, Verena; Telishevska, Marta; Wimbauer, Katharina; Lennerz, Carsten; Ranieri, Elena; Brkić, Amir; Maurer, Sabine; Blažek, Patrick; Bahlke, Fabian; Grebmer, Christian; Kolb, Christof; Deisenhofer, Isabel; Hessling, Gabriele; Kottmaier, Marc

doi:10.1016/j.hroo.2022.02.011

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…In case of complex sedation or high-risk procedures, the SPs can request for direct supervision of an anesthesiologist. Legal requirements for PSA differ all over the world [ 2 ▪ , 7 ▪▪ ]. For example, the United States Food and Drug Administration (FDA) only approves the use of propofol to perform deep sedation by trained sedation providers due to its risk profile [ 12 ].…”

Section: Qualification Of Staff Involved In Procedural Sedation and A...mentioning

confidence: 99%

“…In case of preexisting renal failure or/and chronic hepatic disease adverse events can be reduced by careful selection of medication, adjustment of dose and careful titration for example in patients with reduced clearance. A BMI >30 kg/m 2 has been shown to be an independent predictor for severe persistent hypoxemia during sedation for AF-ablation [ 7 ▪▪ ]. OSAS is the most common subtype of sleep-disordered breathing (SDB) and is highly prevalent in AF-patients [ 14 ▪ ].…”

Section: Patient Evaluationmentioning

confidence: 99%

“…However invasive arterial blood pressure monitoring can be indicated in selected cases. Foerscher recently observed and reported that arterial blood pressure monitoring is indicated for blood pressure control and/or arterial blood gas analysis in 27.8% of the population in a study in patients undergoing left arterial ablation [ 7 ▪▪ ]. The results of this study also showed also a significant blood pressure drop (mean arterial pressure < 60 mmHg) in 12.3% of the cases.…”

Section: Monitoringmentioning

confidence: 99%

“…Combination and use of drugs via one bolus of midazolam, continuous infusion of propofol and boluses fentanyl is often used for deep sedation of patients during AF-ablation [ 7 ▪▪ ]. The combined use of TCI of propofol and remifentanil is expected to increase among anesthesia sedation providers as TCI facilitates precise control over the level of sedation [ 7 ▪▪ ].…”

Section: Medicationmentioning

confidence: 99%

“…A recent study on drug-related complications in a cohort of patients undergoing deep sedation for AF-ablation showed that out of 3211 patients 1 patient (0.03%) desired endotracheal intubation (eIT) and 47 patients (1,5%) required noninvasive ventilation (NIV) [ 7 ▪▪ ]. Those patients which needed eIT and/or NIV experienced an increased duration of sedation procedures, an increased CHA2DS2–VASC score and were characterized by a higher body mass index (BMI) [ 7 ▪▪ ]. The CHA2DS2–VASC score is widely used to estimate cardio-embolic risk in patients with atrial fibrillation [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Optimization of procedural sedation and analgesia during atrial fibrillation ablation

Homberg

Bouman

Joosten

2023

Current Opinion in Anaesthesiology

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Purpose of reviewThis mini-review is aimed to provide an overview and discuss procedural sedation and analgesia for atrial fibrillation (AF) ablation with focus at qualification of staff, patient evaluation, monitoring, medication and postprocedural care.Recent findingsSleep-disordered breathing is highly prevalent in patients with AF. Impact of often used STOP-BANG questionnaire to detect sleep-disordered breathing in AF patients is limited due to its restricted validity. Dexmedetomidine is a commonly used drug in sedation, but is shown not to be superior to propofol in sedation during AF-ablation. Alternatively use of remimazolam has characteristics that makes it a promising drug for minimal to moderate sedation for AF-ablation. High flow nasal oxygen (HFNO) has shown to reduce the risk of desaturation in adults receiving procedural sedation and analgesia.SummaryAn optimal sedation strategy during AF ablation should be based on AF patient characteristics, the level of sedation needed, the procedure (duration and type of ablation) and the education and experience of the sedation provider. Patient evaluation and post procedural care are part of sedation care. More personalized care based on use of various sedation strategies and types of drugs as related to the type of AF-ablation is the way to further optimize care.

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Section: Qualification Of Staff Involved In Procedural Sedation and A...mentioning

confidence: 99%

Section: Patient Evaluationmentioning

confidence: 99%

Section: Monitoringmentioning

confidence: 99%

Section: Medicationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

Homberg

Bouman

Joosten

2023

Current Opinion in Anaesthesiology

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Initiation and maintenance of atrial fibrillation

Bogossian

Robl²,

Bimpong-Buta

et al. 2023

Herzschr Elektrophys

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Feasibility of pulsed field ablation for atrial fibrillation under mild conscious sedation

Calvert,

Mills,

Murray

et al. 2024

J Interv Card Electrophysiol

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Background Pulsed field ablation (PFA) is a new modality for pulmonary vein isolation (PVI) for atrial fibrillation (AF). PFA is performed under general anaesthetic (GA) or deep sedation with propofol, but this requires anaesthetic support in many countries, restricting use. No study has tested the feasibility of PFA under mild conscious sedation (MCS). Methods We prospectively recruited patients undergoing PFA PVI, offered the option of MCS delivered by electrophysiologists, and compared these with patients who opted for GA. MCS comprised intravenous midazolam and fentanyl. All procedures were performed under anaesthetic supervision in case of requirement to convert to GA, which formed the primary outcome. Results Twenty-three patients were recruited (8 MCS, 15 GA). One patient (1/8 [12.5%]) required conversion from MCS to GA. Total procedural times were similar between groups (MCS 92 ± 12.4 min vs. GA 101 ± 17.3 min; p = 0.199). High mean sedative doses were required in the MCS group (5.12 ± 0.83 mg midazolam and 209 ± 40 mcg fentanyl). Median intraprocedural pain perception by the patient, rated from 0 to 100 was 45 (IQR 22.5–72.5) in the MCS group. Post-procedural groin pain (0 [0–0] vs. 5 [0–35]; p = 0.027) and throat pain (0 [0–0] vs. 10 [5–40]; p = 0.001) were lower in the MCS group. Conclusion PFA under MCS is feasible in selected patients but pain and tolerance may be suboptimal, and high sedative doses are required. Graphical abstract

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Deep sedation with propofol in patients undergoing left atrial ablation procedures—Is it safe?

Cited by 10 publications

References 28 publications

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

Optimization of procedural sedation and analgesia during atrial fibrillation ablation

Initiation and maintenance of atrial fibrillation

Feasibility of pulsed field ablation for atrial fibrillation under mild conscious sedation

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