Offsite anesthesiology in the cardiac catheterization lab

Gross, Wendy L.

doi:10.1097/aco.0b013e32827ab47b

Cited by 23 publications

(11 citation statements)

References 51 publications

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“…Radiation exposure to staff is a function of three variables: time; distance; and barrier [15]. Anaesthetists have less control over the total radiation time as it is more dependent upon the operator performing the procedure and on the complexity of the procedure.…”

Section: Discussionmentioning

confidence: 99%

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Radiation exposure to anaesthetists during interventional radiology*

Ismail

Khan

Sultan³

et al. 2009

Anaesthesia

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SummaryThis prospective study determined the level of radiation exposure of anaesthetists during interventional radiological procedures performed in the endoscopic retrograde cholangiopancreatography suite and cardiac catheterisation laboratory and compared it with the current safety guidelines. Anaesthetists wore area-specific lithium fluoride thermo-luminescent dosimeter badges at standardised positions. A total of 1344 procedures were performed over a 6-month period. Anaesthetists were involved in 39 ⁄ 645 (6.0%) procedures associated with ionisation radiation in the endoscopic retrograde cholangiopancreatography suite and 86 ⁄ 699 (12.3%) in the cardiac catheterisation laboratory. The mean (SD) duration of endoscopic retrograde cholangiopancreatography was 54.8 (29.1) min compared with 67.9 (42.8) min for cardiac catheterisation suite procedures (p = 0.058). The mean (SD) fluoroscopy time per procedure for endoscopic retrograde cholangiopancreatography was 5.5 (4.1) min compared with 12 (10.9) min in the cardiac catheterisation suite (p < 0.001). The combined net radiation exposure over 6 months was 0.28 mSv for endoscopic retrograde cholangiopancreatography procedures and 2.32 mSv in the cardiac catheterisation suite. The combined exposure was less than the maximum recommended exposure of 20 mSv per year.

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Section: Discussionmentioning

confidence: 99%

“…Shook and Gross [15] have recommended that every anaesthetist involved in patient care in cardiac catheterisation laboratories should wear a dosimeter to track cumulative radiation exposure. A study by Katz in 2005 [17] looked at the radiation exposure of anaesthetists before and after the introduction of an electrophysiology laboratory.…”

Section: Discussionmentioning

confidence: 99%

Radiation exposure to anaesthetists during interventional radiology*

Ismail

Khan

Sultan³

et al. 2009

Anaesthesia

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“…In one patient, it was necessary to open the thorax medially and perform a heart tamponade decompression. No complications described in the literature occurred, such as stroke, aortic dissection, aortic perforation, myocardial infarction, coronary vessel damage, haemodynamic instability requiring the introduction of extracorporal circulation or complications related to the peripheral vessels [12][13][14]. In two cases, it was necessary to convert local anaesthesia to general anaesthesia.…”

Section: Resultsmentioning

confidence: 99%

Local anaesthesia with analgosedation in patients qualified for transcatheter aortic valve implantation (TAVI): first institute’s results and experiments

Musiał

Lipińska-Strasik

Piątkiewicz

et al. 2017

Anaesthesiol Intensive Ther

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Background: The authors present their own experience of the treatment of patients qualified for transcatheter aortic valve implantation (TAVI) carried out in a modern hybrid operating room. The objective of the present study was to demonstrate the initial results of conducting anaesthesia in high-risk patients qualified for the TAVI procedure (transcatheter aortic valve implantation). In addition, the authors' aim was also to point out to the special challenges of an anaesthesiologist conducting local anaesthesia in such a type of procedures and to evaluate the safety and efficacy of the TAVI procedure conducted under remifentanil analgosedation. Methods: A retrospective analysis included patients treated during the period from September 2015, when local anaesthesia for the transcatheter aortic valve implantation was used for the first time at our centre, up to February 2016. The studied population consisted of 11 patients treated for severe aortic valve stenosis. The mean age of patients was 80 ± 7 years. Three patients were men (27%) and eight were women (73%). The study included all subsequent patients (n = 11), treated in our centre, for whom it was decided to perform TAVI under local anaesthesia. Results: The total hospital mortality rate was 0%. All procedures were performed in a hybrid operating room. Despite the complications observed in the described group, the hospital mortality rate during TAVI was 0%. All patients, after 12 ± 5 days of treatment, left the hospital in a good neurological condition, which was assessed based on the CPC-1 (Cerebra Performance Categories Scale) and GCS-15 (Glasgow Coma Scale) scales. With an ejection fraction of the left ventricle of 53 ± 11%, the transcatheter aortic valve was successfully implanted. Conclusions: Percutaneous aortic valve implantation can be successfully conducted under remifentanil analgosedation. TAVI procedures should be performed in the conditions of a modern, well-equipped hybrid room. The aim of the anaesthesiologist should consist of conducting the least invasive anaesthesia/analgesia, bearing in mind the safety and comfort of the patient.

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“…It is highly recommended to wear leaded eye glasses to reduce the risk of cataracts. Moveable lead shields are used for additional protection from direct radiation exposure, but are less effective in protection from radiation scatter [4].…”

Section: Risk To Anaesthesiologistmentioning

confidence: 99%

“…Patient airway factors that should trigger an anaesthesia consultation include morbid obesity, obstructive sleep apnea, inability to lie flat, suspected difficult airways, chronic obstructive pulmonary disease, low oxygen saturation, congestive heart failure, hemodynamic instability, psychiatric disorders, morbid obesity and any medication that could complicate administration of sedative agents. Left main coronary artery stenting, investigational percutaneous valve procedure, complex arrhythmia ablation, complicated lead extraction and biventricular pacemaker procedures also should have anaesthetic consultation [2]- [4].…”

Section: General Anaesthetic Considerationsmentioning

confidence: 99%

Anaesthetic Challenges in Cardiac Interventional Procedures

Thangavel¹,

Muthukumar²,

Karthekeyan³

et al. 2014

WJCS

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The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different patient categories, complications and safety issues. Collaboration and planning between cardiologist and anaesthesiologist are required for both patient safety and procedural success. This review aims to discuss procedures performed in interventional cardiology and the importance of anaesthesiologists in managing such patients. Percutaneous interventions are being increasingly performed in adult as well as in pediatric patients. Procedures are usually done under mild to moderate sedation. General anaesthesia is required in certain conditions and also in pediatric patients. Knowledge of echocardiography, individual disease condition and fluoroscopy is important. Anaesthesiologists are assuming an increasingly important role in the multidisciplinary management of complex patients and interventions. A comprehensive understanding of procedures is essential to provide a high level of anaesthetic care and maintain patient safety.

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Offsite anesthesiology in the cardiac catheterization lab

Abstract: The anesthesiologist is becoming an integral part of the cardiac catheterization lab team, and an important element in maintaining a high level of patient care with minimal complications in the evolving modern day cardiac catheterization lab.

Cited by 23 publications

References 51 publications

Radiation exposure to anaesthetists during interventional radiology*

Radiation exposure to anaesthetists during interventional radiology*

Local anaesthesia with analgosedation in patients qualified for transcatheter aortic valve implantation (TAVI): first institute’s results and experiments

Anaesthetic Challenges in Cardiac Interventional Procedures

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