Recent advances in nonoperating room anesthesia for cardiac procedures (original) (raw)
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Operator-Directed Procedural Sedation in the Congenital Cardiac Catheterization Laboratory
JACC: Cardiovascular Interventions, 2019
The purpose of this study was to evaluate the association between the method of procedural sedation and outcomes for congenital cardiac catheterization procedures. BACKGROUND The safety of operator-directed sedation (ODS) in the pediatric/congenital cardiac catheterization laboratory has been questioned. To our knowledge, the relative safety of ODS versus general anesthesia (GA) in these cases has not to date been critically evaluated. METHODS A single-center retrospective cohort study was performed to compare the relative safety, cost, and times of catheterization procedures performed with ODS and those performed with GA from a cardiac anesthesiologist. The risk of adverse outcomes was compared using propensity-score-adjusted models. Using the same propensity score, procedure times and relative charges were also compared. RESULTS Over the study period, 4,424 procedures in 2,547 patients were studied. Of these, 27% of cases were performed with ODS. ODS procedures were 70% diagnostic procedures, 17% device closure of patent ductus arteriosus, 5% balloon pulmonary valvuloplasty, and 3% pulmonary artery angioplasty. The risk of adverse event in adjusted models for ODS cases was significantly lower than in GA cases (odds ratio: 0.66; 95% confidence interval: 0.45 to 0.95; p ΒΌ 0.03). Total room time and case time were also significantly shorter (p < 0.001). Professional (charge ratio: 0.88; p < 0.001) and hospital (charge ratio: 0.84; p < 0.001) charges for ODS cases were also lower than those for GA cases. CONCLUSIONS This study demonstrates that clinical judgment can identify subjects in whom ODS is not associated with increased risk of adverse events. The use of ODS was associated with reduced case times and charges. In combination, these findings suggest that the selective use of ODS can allow for greater efficiency and higher value care without sacrificing safety.
Anesthesia in the Cardiac Catheterization Laboratory and Electrophysiology Laboratory
Anesthesiology Clinics, 2009
Procedures and interventions in the cardiac catheterization laboratory (CCL) and electrophysiology laboratory (EPL) are more complex and involve acutely ill patients. Modern procedures take longer to perform, requiring technical precision and greater focus by cardiologists for a successful result. In this new and changing arena, collaboration and planning between cardiologists and anesthesiologists are required for both patient safety and procedural success. The focus of this article is the transformation of that information into a safe and effective anesthesia management plan for the CCL and EPL. THE LABORATORY ENVIRONMENT Becoming familiar with the laboratory workspace and personnel is imperative. Typically there is a control station and procedure room. The control station is shielded from radiation and usually has a technician recording the progress of the procedure. The technician communicates with the cardiologist frequently and controls many aspects of the case, including patient monitoring, video recording and editing, and digital record keeping.
The anesthesiologist and the perioperative environment for the patient with congenital heart disease
Seminars in Anesthesia, Perioperative Medicine and Pain, 2006
The population of patients with repaired or palliated congenital heart lesions has dramatically expanded. Improved surgical procedures and perioperative care have enabled many to survive significantly longer. This is a small but emerging population that requires the anesthesiologist to completely understand the anatomy, physiology, and natural history of the specific disease in order to provide a safe anesthetic. Common hemodynamic issues in this patient population include myocardial dysfunction, pulmonary hypertension, and residual defects, including obstruction and shunting. Residual hemodynamic abnormalities must be understood with respect to the predictable physiological disturbances that occur during anesthesia and the surgical procedure.
Pakistan Armed Forces Medical Journal, 2021
Objective: To examine the types of procedures and analyze the frequency of anesthesia-related complications during pediatric cardiac catheterization. Study Design: A prospective observational study. Place and Duration of Study: Pediatric Cardiac Catheterization Lab at AFIC/NIHD Rawalpindi, from July 2019 to Nov 2019. Methodology: Total 180 consecutive patients undergoing cardiac catheterization fulfilling inclusion criteria were studied. Demographic variables, diseases, type of procedure, variables and anesthesia-related complications were noted. All the data was analyzed using SPSS-23. Results: The study included180 patients where 96 (53.3%) were male and 84 (46.7%) were female. Most of the patients in our study were between ages 1 to 3 years (85). 99 (55.0%) patients had diagnostic cardiac catheterizetion (CC), while 81 (45%) patients underwent interventional procedures. The overall complication rate noted as 18.9%, including arrhythmia in 11.1% followed by hypotension 4.4%, laryn...
Pediatric Cardiology, 2015
Sedation/anesthesia is critical to cardiac catheterization in the pediatric/congenital heart patient. We sought to identify current sedation/anesthesia practices, the serious adverse event rate related to airway, sedation, or anesthesia, and the rate of intra-procedural conversion from procedural sedation to the use of assisted ventilation or an artificial airway. Data from 13,611 patients who underwent catheterization at eight institutions were prospectively collected from 2007 to 2010. Ninety-four (0.69 %) serious sedation/airway-related adverse events occurred; events were more likely to occur in smaller patients (\4 kg, OR 4.4, 95 % CI 2.3-8.2, p \ 0.001), patients with non-cardiac comorbidities (OR 1.7, 95 % CI 1.1-26, p \ 0.01), and patients with low mixed venous oxygen saturation (OR 2.3, 95 % CI 1.4-3.6, p \ 0.001). Nine thousand three hundred and seventy-nine (69 %) patients were initially managed with general endotracheal anesthesia, LMA, or tracheostomy, whereas 4232 (31 %) were managed with procedural sedation without an artificial airway, of which 75 (1.77 %) patients were converted to assisted ventilation/general anesthesia. Young age (\12 months, OR 5.2, 95 % CI 2.3-11.4, p \ 0.001), higher-risk procedure (category 4, OR 10.1, 95 % CI 6.5-15.6, p \ 0.001), and continuous pressor/inotrope requirement (OR 11.0, 95 % CI 8.6-14.0, p \ 0.001) were independently associated with conversion. Cardiac catheterization in pediatric/congenital patients was associated with a low rate of serious sedation/airway-related adverse events. Smaller patients with non-cardiac comorbidities or low mixed venous oxygen saturation may be at higher risk. Patients under 1 year of age, undergoing high-risk procedures, or requiring continuous pressor/inotrope support may be at higher risk of requiring conversion from procedural sedation to assisted ventilation/general anesthesia.