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

Hendrik Südkamp,Rolf Alexander Jánosi,Julia Lortz,Elif Kaya,Tienush Rassaf

doi:10.1038/s41598-018-25457-x

Hendrik Südkamp, Rolf Alexander Jánosi + Show 3 more

Open Access

https://doi.org/10.1038/s41598-018-25457-x

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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.

Highlights

Even complex cardiac implantable electronic device (CIED) procedures are increasingly performed using local anaesthesia with conscious sedation rather than general anaesthesia
Women required significantly higher doses of fentanyl for analgesia than did men (61.0 ± 70.4 μg vs. 42.7 ± 50.2 μg, p = 0.012), but no differences in the procedural duration were noted between women and men (52.7 ± 33.4 min vs. 53.5 ± 46.0 min, p = 0.4)
cardiac resynchronisation therapy (CRT) device implantations took longer than did single- and dual-chamber device implantations (107.3 ± 66.8 min vs. 49.2 ± 33.9 min, p < 0.0001), but no difference in the mean dose of fentanyl was observed between these procedural groups (67.5 ± 59.2 μg vs. 38.9 ± 41.4 μg, p = 0.972)

Summary

Introduction

Even complex cardiac implantable electronic device (CIED) procedures are increasingly performed using local anaesthesia with conscious sedation rather than general anaesthesia. Respect for the mental and psychological status and comorbidities of the patient is the main reason for still using general anaesthesia in complex CIED procedures. This approach is associated with increased risk owing to haemodynamic effects, in elderly patients and patients with heart failure[1,2,3,4,5,6,7,8,9,10,11]. We assessed the feasibility, safety, and efficacy of local anaesthesia combined with conscious sedation using midazolam and propofol plus fentanyl

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