Isoproterenol infusion increases level of consciousness during catheter ablation of atrial fibrillation

Abstract

Isoproterenol infusion alters consciousness level during total intravenous anesthesia for atrial fibrillation ablation. BIS monitoring is a novel way to modulate anesthesia during ablation to potentially optimize patient comfort and ablation success.

Escape From Oblivion: Neural Mechanisms of Emergence From General Anesthesia

“…Studies in humans using processed electroencephalographic demonstrate that systemic administration of ephedrine or isoproterenol activates the cortical electroencephalographic and rouses the cortex. 52,53 Studies in rodents demonstrate that more localized delivery of norepinephrine into the brain of anesthetized animals also leads to signs of arousal. Compared to saline controls, infusions of norepinephrine into the basal forebrain targeting the nucleus basalis of Meynert cause transient behavioral and electroencephalographic activation despite continuous, steady-state desflurane anesthesia.…”

Isoproterenol Increases BIS and Arousal during Catheter Ablation for Atrial Fibrillation

“…Although important during AF ablation, administration of Isoproterenol counteracts the sedative effect of general anesthesia as demonstrated in our previous study reported in JICE [6]. Movement still poses a risk to the patient and has been shown to adversely affect outcome [2].…”

“…This study utilized a formal isoproterenol infusion protocol and controlled mechanical ventilation. In the pilot study [6] the median isoproterenol dose was 25 mcg with arbitrary dosing, spontaneous ventilation and mild hypercarbia, this study with the isoproterenol infusion protocol had a mean isoproterenol dose of 146.8 mcg with normocarbia.…”

“…A pilot study (N=7) by our research group, showed that the bispectral index (BIS) increased dramatically with isoproterenol administration to patients under anesthesia, although no patient had any recall of events [6]. A single patient case report also reported that isoproterenol administration increased the BIS index [7].…”

Outcomes of deep sedation for catheter ablation of paroxysmal supraventricular tachycardia, with adaptive servo ventilation

“…Our target for BIS sedation level was 40 which corresponds to a Ramsay sedation score of 6 14 . Interestingly, it is reported that administration of ISP itself often alters BIS level 15 . Careful BIS‐level monitoring is needed before and after ISP administration because ISP is frequently needed for tachycardia induction in this anesthesia strategy.…”