Conscious Sedation and Implantable Devices: Safe and Effective Sedation during Pacemaker and Implantable Cardioverter Defibrillator Placement

Abstract

There is a paucity of research on the use of CS during ICD or pacemaker implantation. Pacemaker patients generally require small amounts of i.v. sedation, in conjunction with local anesthetic agents, to relieve incisional discomfort. Because of innovations in ICD technology, little difference now exists between ICD and pacemaker placement. Studies have reported on the use of deep sedation during ICD implantations, but only one study addressed CS in ICD placement. Whether deep levels of sedation are necessary for DFT testing is not apparent from these studies. Two studies report giving sedation at a level consistent with deep sedation, yet partial loss of protective reflexes was not reported in one of the studies. Further research is needed to explore the use of sedation in ICD implantation. It may be that deep sedation for patient comfort is necessary only during DFT testing or for tunneling of leads to an abdominal generator site, and that CS is more than appropriate for the implant portion of the procedure. Research may disclose that agents such as midazolam and, to some extent propofol, provide an amnesic effect that may mitigate the need for deep sedation during DFT testing or lead tunneling. Another benefit of agents and analgesics such as Fentanyl, is the relatively short duration of sedation, which minimizes recovery time. Patients recover quicker than with general anesthesia and can be discharged the same day in some procedures (e.g., generator replacement). Cost-benefit studies also are needed to compare the cost of anesthesiologist-delivered sedation with that of nurse-administered sedation. A comparison study could explore complication rates, patient comfort, and costs for the two sedation delivery methods.