Conscious sedation and analgesia use in cardiac device implantation

Looi, Khang‐Li; Lee, Audry S.Y.; Cole, Katherine; Agarwal, Sharad; Heck, Patrick; Begley, David; Grace, Andrew A.; Virdee, Munmohan; Fynn, Simon P.

doi:10.1016/j.ijcard.2013.01.167

Cited by 12 publications

(21 citation statements)

References 8 publications

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“…Without an anesthetist, concerns about the safety of sedation have been stated since some patients can exhibit a paradoxical response where there is involuntary movement of all or some parts of their bodies despite sedation, which disturbs the procedure, or requiring further sedation or general anesthesia . Looi et al showed that the use of conscious sedation with the low dosages of intravenous midazolam and fentanyl was safe for CIEDs implantation without an anesthetist involvement . However, they did not give the detailed information about the training and experiences of the person who administered the sedation.…”

Section: Discussionmentioning

confidence: 99%

“…Excess amount of local anesthetic (LA) administration may cause inadequate wound healing and intoxication as well as overdosing of sedatives. Moreover, analgesics may disrupt the circulation . Performed under US guidance, pectoral nerves (PECS) block is a comparatively novel and safe peripheral nerve block that targets the lateral and median PECS at an interfacial plane between the pectoralis major and minor muscles .…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound‐guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices

Bozyel

Yalnız

Aksu

et al. 2019

Pacing Clinical Electrophis

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Background:Combined ultrasound (US)-guided pectoral nerves (PECS) block and axillary vein (AV) puncture for cardiac implantable electronic devices can be effective to achieve optimal perioperative pain management and prevent access-related complications. Methods:A total of 36 patients who underwent combined US-guided PECS block and AV puncture were included. All routinely recorded parameters, including clinical and demographic characteristics, periprocedural medical administrations, the time taken for both PECS block and AV puncture, procedure time, postprocedural pain score, and procedure-related complications, were collected and analyzed. Results: In total, 54 leads were placed in 36 patients. The combined US-guided PECS block and AV puncture was performed successfully in 35 (97.2%) patients without the need for fluoroscopy or venography. AV access for each lead was achieved in a single attempt in 80.6% of cases. The time for both PECS block and AV puncture was 223.6 ± 52.1 s, including the time to apply incision site anesthesia. Additional sedatives and/or local anesthetics were required in two patients during procedure. Visual analog scale average of the patients in the 1st, 6th, and 24th h was 3.7 ± 1.14. 1.61 ± 1.29, and 0.08 ± 0.28, respectively. After the procedure, four patients (three of them woman) needed analgesics. There were no venous access-related complications. Conclusions: This new combined technique maintains both surgical and postoperative analgesia and prevents vascular access-related complications without significant increase on procedure time. K E Y W O R D S axillary vein, cardiac implantable electronic devices, pectoral nerve block, ultrasound, venous access 1 1026

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices

Bozyel

Yalnız

Aksu

et al. 2019

Pacing Clinical Electrophis

View full text Add to dashboard Cite

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“…Analgesia and sedation during CRTD implantation is often challenging, as systemic administration of sedatives and analgesics can disturb circulation (Looi et al 2013). PECS block is a relatively new peripheral nerve block strategy for breast surgery pain management (Blanco 2011) (Blanco et al 2012).…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…Effective analgesia and sedation during cardiac resynchronization therapy device (CRTD) implantation is important from the perspectives of surgical procedure and circulation stability (Looi et al 2013). …”

Section: Introductionmentioning

confidence: 99%

Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation

2014

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A 71-year-old man was scheduled to undergo cardiac resynchronization therapy device (CRTD) implantation. He was combined with severe chronic heart failure due to ischemic heart disease. NYHA class was 3 to 4 and electrocardiogram showed non-sustained ventricular. Ejection fraction was about 20% revealed by transthoracic echocardiogram. He was also on several anticoagulation medications. We planned to implant the device under the greater pectoral muscle. As general anesthesia was considered risky, monitored anesthesia care utilizing peripheral nerve block and slight sedation was scheduled. Pectoral nerves (PECS) block and intercostal block was performed under ultrasonography with ropivacaine. For sedation during the procedure, continuous infusion of dexmedetomidine without a loading dose was performed. The procedure lasted about 3 hours, but the patient showed no pain or restlessness. Combination of PECS block and intercostal block may provide effective analgesia for CRTD implantation.

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“…13 Furthermore, one of the great advantages of using conscious sedation is the reduced anxiety and patient discomfort, which decreases the risks that might be caused by general anaesthesia. 16 A nother great advantage is the presence 10,20 It also has a known anterograde amnesic effect. 21 Due to these properties, it is the most commonly used sedating medication in children.…”

Section: Literature Review Benzodiazepinesmentioning

confidence: 99%

Sedation with oral benzodiazepines in dental practice in cardiac patients

et al. 2019

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| There are different types of sedation used for performing medical and dental procedures. The medications most commonly used for this purpose are benzodiazepines, which are considered safe and effective in the hospital or outpatient dental practice. However, in dental clinical practice, they are underutilized, especially in patients with cardiovascular disease. The aim of this study was to address the use of benzodiazepines as oral sedatives, their indications, contraindications, and peculiarities, as well as their correlation with cardiac patients, through a literature review. Sedation or minimum anxiolysis is a drug-induced state during which patients respond normally to verbal commands and airway reflexes, while respiratory and cardiovascular functions are unaffected. The beneficial effects of benzodiazepines include reduced anxiety, sleep induction and maintenance, muscle relaxation, and treatment and prevention of epileptic seizures. Benzodiazepines are indicated for patients with anxiety but should be used with caution in patients with serious illnesses, pregnancy or using other central nervous system depressants. Its use in cardiac patients is safe and effective because it reduces the hemodynamic function. It is important for the dentist to know and use this class of medications, improving the quality of care for the cardiac patient. KEYWORDS | Benzodiazepines; Heart Disease; Dentistry.RESUMO | Sedação com benzodiazepínicos orais na prática odontológica em pacientes cardíacos: uma revisão de literatura • Existem diferentes tipos de sedação utilizados para a realização de procedimentos médicos e odontológicos. As medicações mais comumente usadas para este fim são os benzodiazepínicos, considerados seguros e efetivos na prática odontológica hospitalar ou ambulatorial. No entanto, na prática clínica odontológica, eles são subutilizados, especialmente em pacientes com doenças cardiovasculares. O objetivo deste estudo foi abordar o uso de benzodiazepínicos como sedativos orais, suas indicações, contraindicações e peculiaridades, bem como sua correlação com pacientes cardíacos, através de uma revisão da literatura. Sedação, ou ansiólise mínima, é um estado induzido por medicamentos, durante o qual os pacientes respondem normalmente a comandos verbais e reflexos das vias aéreas, enquanto a função respiratória e cardiovascular não é afetada. Os efeitos benéficos de benzodiazepínicos incluem redução da ansiedade, indução e manutenção do sono, relaxamento muscular e tratamento e prevenção de convulsões epiléticas. Benzodiazepínicos são indicados para pacientes com ansiedade, mas devem ser usados com cautela em pacientes com doenças graves, gravidez ou que utilizem outros depressores do sistema nervoso central. É importante que o dentista conheça e use esta classe de medicamentos, melhorando a qualidade de atendimento para o paciente cardíaco.

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Conscious sedation and analgesia use in cardiac device implantation

Cited by 12 publications

References 8 publications

Ultrasound‐guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices

Ultrasound‐guided combined pectoral nerve block and axillary venipuncture for the implantation of cardiac implantable electronic devices

Pectoral nerves (PECS) and intercostal nerve block for cardiac resynchronization therapy device implantation

Sedation with oral benzodiazepines in dental practice in cardiac patients

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