Pain Control and Hemodynamic Changes due to Moderate Sedation during Cardiac Catheterization

Abstract

Background: Moderate sedation is a practice of promoting patient comfort during cardiac catheterization. However, few studies have evaluated the effectiveness of moderate sedation in patients undergoing cardiac catheterization. Objective: To determine the efficacy of moderate sedation in patients undergoing cardiac catheterization. Materials and Methods: The authors retrospectively analyzed patients undergoing cardiac catheterization. They were divided into the moderate sedation group, which received midazolam, fentanyl, or combined midazolam and fentanyl, and the control group, which received no sedative medication. The primary endpoint was self-reported pain score during the procedure. The secondary endpoint was a hemodynamic variation during the procedure. Propensity-score matching was used to reduce confounding biases. Results: One hundred ninety-six patients were included, with 111 patients in the moderate sedation group and 85 patients in the control group. The proportion of patients who experienced any pain was significantly lower in the moderate sedation group than in the control group at 3.6% versus 11.8% (p=0.028). No significant difference was found in the average change in the systolic blood pressure at –9 mmHg versus –4 mmHg (p=0.097) and the heart rate at –1 bpm versus –2 bpm (p=0.289) obtained at baseline and that at the end of the procedure between the moderate sedation group and the control group. However, the change in the diastolic blood pressure (DBP) measured at baseline and at the end of the procedure was significantly lower in the moderate sedation group than in the control group at –4 mmHg versus –1 mmHg (p=0.039). Conclusion: Moderate sedation by using a low-dose fentanyl, midazolam, or combined fentanyl and midazolam is associated with fewer episodes of pain and better DBP stability during cardiac catheterization. Keywords: Conscious sedation; Midazolam; Coronary angiography; Percutaneous coronary intervention; Cardiac catheterization