Anaesthesia for cardioversion

Stoneham,

doi:10.1111/j.1365-2044.1996.tb12566.x

Cited by 28 publications

(11 citation statements)

References 57 publications

(26 reference statements)

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“…Propofol has been used for procedural sedation in Emergency Medicine since 1995 7. In 1996, in a review article in Anaesthesia ,8 it was recommended as the drug which most closely approaches the ideal agent for cardioversion; however, a systematic review of the use of propofol for procedural sedation in Emergency Medicine in 2001 concluded that although there was evidence to support the use of propofol for DCCV this evidence came from stable patients in a non-ED setting, and there was as yet no evidence to support its use in emergency practice 9. Since then, Miner et al 10 have shown that procedural sedation in the ED with propofol appears to be safe in ASA class III and IV patients.…”

Section: Discussionmentioning

confidence: 99%

Procedural sedation with propofol for emergency DC cardioversion

Kaye

Govier

2013

Emerg Med J

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Many emergency patients present with cardiac arrhythmias requiring emergency direct current countershock cardioversion (DCCV) as a part of their management. Almost all require sedation to facilitate the procedure. Propofol has been used for procedural sedation in Emergency Medicine since 1995. In 1996, in a review article in Anaesthesia, it was recommended as the drug which most closely approaches the ideal agent for DCCV. However, the existing evidence for the dosage requirements and safety of propofol in emergency DCCV is limited. We report a prospective case series of patients who underwent sedation-facilitated DCCV using propofol in the emergency department with both sedation and DCCV delivered by emergency physicians. The results indicate propofol is a safe drug for procedural sedation to facilitate emergency DCCV in patients with an atrial tachyarrhythmia without any evidence of haemodynamic compromise. A dose of 1 mg/kg appears to be safe in the majority of these patients. Using the adverse event reporting tool produced by the World SIVA International Sedation Task Force there were no moderate or sentinel adverse events in these patients. A reduced dose should be considered in older patients to prevent transient complications. Propofol at a dose of 0.5 mg/kg appears to be a safe drug for procedural sedation to facilitate emergent or urgent DCCV in patients with an atrial tachyarrhythmia with evidence of haemodynamic compromise. There were no sentinel adverse events associated with its use. Evidence to support the use of propofol to facilitate emergency DCCV for ventricular tachycardia is limited.

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Section: Discussionmentioning

confidence: 99%

Procedural sedation with propofol for emergency DC cardioversion

Kaye

Govier

2013

Emerg Med J

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“…Several studies have indicated that patients' reactions may complicate CV procedures. 1,19,32 Payen et al evaluated patient reactions by using a Behavioral Pain Scale 33 and reported that the medication dosage can be adjusted by this scale. Ammer et al applied low-voltage intracardiac CV.…”

Section: Discussionmentioning

confidence: 99%

“…Preexisting conditions such as previous myocardial infarction, congestive heart failure, angina, hypertension, chronic renal failure, chronic hepatic insufficiency, electrolyte imbalance, other concurrent medications, and the age of the patient have been considered in the selection of agents. [1][2][3][4][5][6][7][8][9][10] Midazolam and propofol frequently have been used for CV sedation. [11][12][13][14][15][16][17] However, different studies report different application techniques, doses, and side effects, [2][3][4][6][7][8]10,12,15,[18][19][20][21] and data on age-specific efficacy and side effects of midazolam and propofol when used in procedural sedation have been limited.…”

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confidence: 99%

Age Effect on Efficacy and Side Effects of Two Sedation and Analgesia Protocols on Patients Going through Cardioversion: A Randomized Clinical Trial

Parlak

Erdur

et al. 2006

Academic Emergency Medicine

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“…Other anesthetic agents used for cardioversion include etomidate, sodium thiopental, and midazolam. 5,6 The success of cardioversion depends on the delivery of adequate current to the heart. Internal cardioversion is rarely used in clinical practice as it is an invasive procedure, and current external cardioversion techniques are successful in most patients.…”

Section: Electrical Cardioversionmentioning

confidence: 99%

Contemporary Approach to Electrical and Pharmacological Cardioversion of Atrial Fibrillation

Rajagopalan

Curtis

2012

Postgraduate Medicine

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In patients with atrial fibrillation (AF), a rhythm-control strategy may be adopted when there are unacceptable symptoms from AF, failure of rate control, and/or the presence of comorbidities, such as heart failure, that may improve with restoration of sinus rhythm. When a rhythm-control strategy is chosen and the patient is in persistent AF, cardioversion will be necessary to convert the rhythm to sinus. Patients with AF present for > 48 hours must be effectively anticoagulated both prior to and after cardioversion. With newer oral anticoagulants, achieving effective anticoagulation is faster and more reliable, with no requirement for blood test monitoring. Cardioversion can be accomplished either electrically or pharmacologically, and in some cases, electrical cardioversion may be facilitated pharmacologically. Electrical cardioversion has a higher success rate compared with pharmacological cardioversion in the short-term. Pharmacological cardioversion is usually accomplished with intravenous ibutilide, oral flecainide or propafenone, or intravenous amiodarone. Oral amiodarone and dofetilide also result in chemical cardioversion in some patients over a longer period of time. Long-term success in the maintenance of sinus rhythm post-cardioversion can be increased with the use of antiarrhythmic drugs. Alternatively, when AF is recurrent and symptomatic despite the use of antiarrhythmic drugs, catheter ablation is a reasonable option for many patients. Cardioversion may be incorporated into the management approach of persistent AF when the primary therapeutic option chosen is catheter ablation.

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Anaesthesia for cardioversion

Abstract: SummaryCarcliocersion is a nzinor procedure requiring sedation and uiiulgesia. HobLwer, it is often pei;fornied out-of-hours

Cited by 28 publications

References 57 publications

Procedural sedation with propofol for emergency DC cardioversion

Procedural sedation with propofol for emergency DC cardioversion

Age Effect on Efficacy and Side Effects of Two Sedation and Analgesia Protocols on Patients Going through Cardioversion: A Randomized Clinical Trial

Contemporary Approach to Electrical and Pharmacological Cardioversion of Atrial Fibrillation

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