Anesthesia for cardiac catheterization procedures

Anesthesiologist's involvement for the purpose of diagnostic and interventional procedures in cardiac catheterization laboratory has been evolving particularly since last two decades. Catheterization laboratory environment poses certain challenges for the anesthesiologist including unfamiliar remote location, exposure to radiation, limited help from colleagues and communication with cardiologists. Anesthesiologists working in catheterization laboratory are required to have adequate knowledge of the environment, personnel, fluoroscope, echocardiography and type of radio contrast dye during the procedure. Anyone who is exposed to radiation environment is expected to protect himself from the exposure and must also wear a dosimeter for cumulative exposure tracing. There is no ideal anesthetic technique and the decision about sedation, general anesthesia or regional anesthesia for the procedure has to be made by attending anesthesiologists in consultation with cardiologists. Anesthesiologists should always try to minimize the effects of anesthesia on cardiovascular system. In addition, oxygenation and ventilatory management should be done according to the diagnostic procedure as it can also influence the diagnosis particularly in pediatric cath procedures. Since more complex procedures are being done in cardiac catheterization laboratory, it is the responsibility of anesthesia department to train and assign dedicated anesthesioloists for new challenges. Role of anesthetist should be well defined so that there is no confrontation during patient management. Sedation in cardiac catheterization laboratory by non-anesthetists is also an issue, which can be sorted out by making policies and protocol in consultation with cardiologists.