A retrospective analysis of proceduralist-directed, nurse-administered propofol sedation for implantable cardioverter-defibrillator procedures

Sedation in the Electrophysiology Laboratory: A Multidisciplinary Review

“…It is noteworthy that the majority of patients were administered propofol by continuous infusion and use of continuous infusions was conspicuously higher in the group that had more serious adverse events (91% versus 73%, P =0.001). Greater total doses of propofol were also associated with higher adverse event rates ( P =0.001) . A second prospective observational study using propofol in 269 consecutive patients undergoing a cardiovascular implantable electronic devices procedure, including lead extraction, reported a respiratory complication rate of 19% (comprising hypoxia 86%, apnea 30%, and aspiration 2%).…”

“…In contrast to the above studies, Sayfo et al performed a single‐center retrospective review of PDNA sedation with propofol for 582 ICD implants. They reported a 10% rate of 1 or more serious events, including 1 requiring intubation for excess sedation, 4 requiring unplanned intensive‐care unit admission for hypoxemia, 9 requiring PPV, and 47 needing significant hemodynamic support.…”

“…Although the provision of GA requires a dedicated anesthesia provider, controversy exists as to whether intravenous sedation in this complex patient population can or should be undertaken by a proceduralist‐directed nurse‐administered (PDNA) model. In a recent survey of 38 national academic centers, electrophysiologists noted that in 26.3% of EP cases, an anesthesiologist is warranted most of the time or always due to patient complexity, yet there is also ample literature espousing the safety and benefits of PDNA sedation for these cases . Moreover, intended sedation plans may require modification over the course of a procedure.…”

Anaesthesiological support in a cardiac electrophysiology laboratory

“…8,9 For the past few years, most authors have suggested a combination of sedation and local anaesthesia. [10][11][12][13] However, anaesthetic supervision and practice vary widely among centres. 14 The aim of this prospective, observational study was to describe the rate, clinical characteristics and risk factors for complications occurring during CIED implantation involving an anaesthetic team in a university hospital.…”

Anaesthetist support during sedation for patients undergoing minimally invasive procedures outside the operating room

“…6 Inadequate sedation, however, may interfere with patient and operator comfort compromising the procedural result and eventually increasing the risk of cardiac complications due to patient stress. 6 Inadequate sedation, however, may interfere with patient and operator comfort compromising the procedural result and eventually increasing the risk of cardiac complications due to patient stress.…”