Feasibility and safety of using local anaesthesia with conscious sedation during complex cardiac implantable electronic device procedures

Abstract

We assessed the feasibility and safety of using local anaesthesia with conscious sedation as an alternative to general anaesthesia during complex and noncomplex cardiac implantable device procedures. We enrolled 279 consecutive patients who underwent cardiac device implantation/replacement at our tertiary/quaternary cardiac specialist hospital during a 17-month study period. Continuous combined intravenous conscious sedation with propofol and midazolam plus fentanyl and local anaesthesia were used for all procedures. Among the patients, 113, 59, 43, and 64 patients underwent pacemaker implantation, implantable cardiac defibrillator implantation, cardiac resynchronisation therapy device implantation, and generator exchange, respectively. The procedural success rate was 100%, with no apnoea or hypoxia episodes requiring therapeutic intervention. None of the patients required conversion to general anaesthesia. The mean surgical duration was longer for complex vs. noncomplex procedures (p = 0.003). The minimum mean arterial pressure during complex procedures was slightly lower than that during noncomplex procedures (p = 0.03). The perioperative (<24 h) mortality rate was 0%, and neither complexity group required tracheal intubation. Only two patients (0.7%) required unplanned intensive care unit admission for further surveillance. Our findings suggest that local anaesthesia with conscious sedation is a safe and feasible option for cardiac device implantation procedures, including complex procedures.

<p>Analgesic Effectiveness of Ultrasound-Guided Pecs II Block in Central Venous Port Catheter Implantation</p>

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Comparison of dexmedetomidine with midazolam for dental surgery

“…Every surgical procedure may lead to apprehension and anxiety, and good sedation is effective to reduce pain and anxiety for improved patient cooperation and satisfaction. [ 21 – 25 ] The comparative evaluation of midazolam and dexmedetomidine is conducted by the intravenous or intranasal route. One study compares intravenous propofol with fentanyl and midazolam with fentanyl for third molar surgery and finds no significant reduction in vital parameters (SpO 2 , pulse rate, and blood pressure).…”

Ultrasound‐guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices

“…In another study, local anesthesia with conscious sedation (combination of midazolam and propofol with fentanyl) has also been shown to be a reliable option for CIED procedures. However, the procedures were carried out by an experienced anesthesiologist or cardiologist in addition to two nurses with experience in airway management and advanced life support …”