General anesthesia during atrial fibrillation ablation: Standardized protocol and experience

被引:14
作者
Osorio, Jose [1 ]
Rajendra, Anil [1 ]
Varley, Allyson [2 ]
Henry, Robert [1 ]
Cunningham, Julie [1 ]
Spear, William [3 ]
Morales, Gustavo [1 ]
机构
[1] Arrhythmia Inst Grandview, 3686 Grandview Pkwy,Suite 720, Birmingham, AL 35243 USA
[2] Heart Rhythm Clin & Res Solut, Birmingham, AL USA
[3] Advocate Christ Med Ctr, Oak Lawn, IL USA
来源
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY | 2020年 / 43卷 / 06期
关键词
atrial fibrillation; catheter ablation; general anesthesia; sedation; ventilator setting; POSTOPERATIVE QUALITY; CRYOBALLOON ABLATION; CATHETER ABLATION; HIGH-FREQUENCY; PROPOFOL; SEDATION; VENTILATION; SURGERY; NODE; AF;
D O I
10.1111/pace.13928
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Most atrial fibrillation (AF) ablations are performed with general anesthesia (GA). The ideal GA protocol is unknown, but it affects ablation outcomes and laboratory utilization. We sought to report a GA protocol used at a high-volume center, with special consideration on efficiency and optimization of mapping and ablation conditions. Methods Our protocol consists of propofol as sole anesthetic agent and analgesia with Fentanyl. IV fluids are minimized. After transseptal access, the right phrenic nerve is tagged, rocuronium is given, and redosing avoided. Ventilation is modulated to optimize mapping and ablation. After ablation, isoproterenol is infused for 20 min. After 10 min, propofol is gradually decreased and ventilation set to SIMV 8 breaths/min to promote spontaneous breathing, and then switched to pressure support and propofol stopped. Paralysis is reversed and furosemide given. Patient is extubated once meeting standard criteria. Results A total of 1286 patients underwent AF ablation from January 2017 to December 2018 using the protocol. Mean age was 66 years (41% paroxysmal AF, CHADS2Vasc 2.6). Total procedure time was 86 min. Median time to extubation was 9 min (first and third quartile 6-16) after procedure completed, with total anesthesia time of 116 min. On average 370 mL of fluids were given by anesthesia. Only one patient who had heart failure required reintubation with no other anesthesia-related complications seen. Conclusion Our GA protocol was specifically designed for AF ablation. It was safe and led to efficient recovery and extubation times. It maximizes laboratory utilization time without compromising safety.
引用
收藏
页码:602 / 608
页数:7
相关论文
共 23 条
[1]   Same-day discharge in selected patients undergoing atrial fibrillation ablation [J].
Bartoletti, Stefano ;
Mann, Mandeep ;
Gupta, Akanksha ;
Khan, Abdul Muhaymin ;
Sahni, Ankita ;
El-Kadri, Moutaz ;
Modi, Simon ;
Waktare, Johan ;
Mahida, Saagar ;
Hall, Mark ;
Snowdon, Richard ;
Todd, Derick ;
Gupta, Dhiraj .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 2019, 42 (11) :1448-1455
[2]  
Calkins H, 2017, HEART RHYTHM, V14, pE445, DOI [10.1016/j.hrthm.2017.07.009, 10.1016/j.hrthm.2017.05.012, 10.1093/europace/eux275]
[3]  
Chen XD, 2018, PAK J PHARM SCI, V31, P2909
[4]   General anesthesia improves contact force and reduces gap formation in pulmonary vein isolation: a comparison with conscious sedation [J].
Chikata, Akio ;
Kato, Takeshi ;
Yaegashi, Takanori ;
Sakagami, Satoru ;
Kato, Chieko ;
Saeki, Takahiro ;
Kawai, Keiichi ;
Takashima, Shin-ichiro ;
Murai, Hisayoshi ;
Usui, Soichiro ;
Furusho, Hiroshi ;
Kaneko, Shuichi ;
Takamura, Masayuki .
HEART AND VESSELS, 2017, 32 (08) :997-1005
[5]   General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: Results from a randomized study [J].
Di Biase, Luigi ;
Conti, Sergio ;
Mohanty, Prasant ;
Bai, Rong ;
Sanchez, Javier ;
Walton, David ;
John, Annie ;
Santangeli, Pasquale ;
Elayi, Claude S. ;
Beheiry, Salwa ;
Gallinghouse, G. Joseph ;
Mohanty, Sanghamitra ;
Horton, Rodney ;
Bailey, Shane ;
Burkhardt, J. David ;
Natale, Andrea .
HEART RHYTHM, 2011, 8 (03) :368-372
[6]   High-Frequency, Low Tidal Volume Ventilation to Improve Catheter Stability During Atrial Fibrillation Ablation [J].
Gabriels, James ;
Donnelly, Joseph ;
Khan, Mohammad ;
Anca, Diana ;
Beldner, Stuart ;
Willner, Jonathan ;
Epstein, Laurence M. ;
Patel, Apoor .
JACC-CLINICAL ELECTROPHYSIOLOGY, 2019, 5 (10) :1224-1226
[7]   Sedation and Analgesia in the Cardiac Electrophysiology Laboratory: A National Survey of Electrophysiologists Investigating the Who, How, and Why? [J].
Gaitan, Brantley Dollar ;
Trentman, Terrence L. ;
Fassett, Sharon L. ;
Mueller, Jeff T. ;
Altemose, Gregory T. .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2011, 25 (04) :647-659
[8]   High-frequency jet ventilation: Utility in posterior left atrial catheter ablation [J].
Goode, JS ;
Taylor, RL ;
Buffington, CW ;
Klain, MM ;
Schwartzman, D .
HEART RHYTHM, 2006, 3 (01) :13-19
[9]  
HAMA Y, 2017, EUROPACE S3, V19, DOI DOI 10.1093/EHJCI/EUX141.040
[10]   Patient well-being after general anaesthesia:: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia [J].
Hofer, CK ;
Zollinger, A ;
Büchi, S ;
Klaghofer, R ;
Serafino, D ;
Bühlmann, S ;
Buddeberg, C ;
Pasch, T ;
Spahn, DR .
BRITISH JOURNAL OF ANAESTHESIA, 2003, 91 (05) :631-637