Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel

Kezerashvili, Anna; Fisher, John D.; Delaney, Jessica; Mushiyev, Savi; Monahan, Eileen; Taylor, Vanessa; Kim, Soo G.; Ferrick, Kevin J.; Gross, Jay N.; Palma, Eugen C.; Krumerman, Andrew

doi:10.1007/s10840-007-9191-0

Cited by 36 publications

(37 citation statements)

References 37 publications

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“…The trainee must acquire the procedural skills to implant singleor dual-chamber pacemakers safely, which includes the appropriate use of antibiotic therapy and other procedural measures to avoid infection, hemodynamic collapse, significant bleeding, pneumothorax, or cardiac perforation. The trainee must also be proficient in the safe use of anticoagulants, procedural sedation, [48][49][50][51] techniques to minimize radiation exposure, and techniques to handle suboptimal venous access. Additionally, the trainee must learn to recognize potential complications quickly and be able to initiate appropriate therapy.…”

Section: Implantable Devicesmentioning

confidence: 99%

2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion)

Zipes¹,

Calkins²,

Daubert

et al. 2015

Circ: Arrhythmia and Electrophysiology

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. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://my.americanheart.org/statements and select the "Policies and Development" link.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/CopyrightPermission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page.(Circ Arrhythm Electrophysiol. PreambleSince the 1995 publication of its Core Cardiovascular Training Statement (COCATS), the American College of Cardiology (ACC) has played a central role in defining the knowledge, experiences, skills, and behaviors expected of all clinical cardiologists upon completion of training. Subsequent updates have incorporated major advances and revisions-both in content and structure-including, most recently, a further move toward competency (outcomes)-based training, and the use of the 6-domain competency structure promulgated by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties, and endorsed by the American Board of Internal Medicine (ABIM). A similar structure has been used by ACC to describe the aligned general cardiovascular lifelong learning competencies that all practicing cardiologists are expected to maintain. Many hospital systems also now use the 6-domain structure as part of medical staff privileging and peer-review professional competence assessments.Whereas COCATS has focused on general clinical cardiology, ACC Advanced Training Statements define selected competencies that go beyond those expected of all cardiologists and require training beyond a standard 3-year cardiovascular disease fellowship. This includes sub-subspecialties for which there is an ABIM added-qualification designation, such as clinical cardiac electrophysiology (CCEP). The Advanced Training Statements also describe key experiences and outcomes necessary to maintain or expand competencies during practice. The ACC Competency Management Committee oversees the development and periodic revision of the cardiovascular training and competency statements. A key feature of competency-based training and performance is an outcome-based evaluation system. Although specific areas of training may require a minimum number of procedures or duration of training time to ensure adequate exposure to the range of clinical disorders and to effectively evaluate the trainee, it is the objective assessment of proficiency and outcomes that demonstrates the trainee's achievement of competency. Such evaluation tools may include in-training examinations, direct observation, procedure logbooks, simulation, conference presentations, and multisource (360°) evaluations, among others. For practicing physicians,...

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Section: Implantable Devicesmentioning

confidence: 99%

2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion)

Zipes¹,

Calkins²,

Daubert

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…Therefore a pre-procedural assessment and application of suitability criteria is considered an essential process prior to IVS [7][8][9]. Pre-procedural assessment should be performed on all patients where the need is not precluded by an urgent requirement for immediate intervention.…”

Section: Pre-[ 5 _ T D $ D I F F ] Procedural Assessment and Patient mentioning

confidence: 99%

“…In most studies there are very few absolute contraindications to IVS [7][8][9][10][11][12]. As noted above, obstructive sleep apnoea is a potential contraindication.…”

Section: Contraindications To Intravenous Sedationmentioning

confidence: 99%

“…As noted above, obstructive sleep apnoea is a potential contraindication. Because of the complexity of the procedure and the associated unpredictable need to convert to open thoracotomy, chronic device lead extraction procedures are usually performed under general anaesthesia [7]. Thus, it is usually considered a contraindication to IVS.…”

Section: Contraindications To Intravenous Sedationmentioning

confidence: 99%

“…There is a large body of evidence documenting the safety of benzodiazepine-narcotic combinations for a variety of cardiac procedures [7][8][9][10]12,[17][18][19][20][21]. The required dose of sedation varies widely.…”

Section: Pharmacological Agentsmentioning

confidence: 99%

See 2 more Smart Citations

CSANZ Position Statement on Sedation for Cardiovascular Procedures (2014)

Thomas

Thakkar

Kovoor

et al. 2015

Heart, Lung and Circulation

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The Cardiac Society of Australia and New Zealand (CSANZ) Position Statement describes evidence-based standards of training, pre-procedural assessment, procedural conduct and post-procedure care with respect to sedation for cardiovascular procedures. It also describes the environment in which sedation for electrophysiological and other cardiac procedures may be performed. This Statement was developed by a Working Group of the Cardiac Society of Australia and New Zealand. It was reviewed by the Continuing Education and Recertification Committee and ratified at the CSANZ Board meeting held on Friday 7 March 2014.

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A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Norii

Kimura²,

Homma³

et al. 2018

Acute Medicine & Surgery

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Aim Worldwide, health‐care providers carry out procedural sedation and analgesia (PSA) in the emergency department. However, training opportunities are limited in many Asian countries, including Japan. We formed an educational group consisting of board‐certified emergency physicians in the USA and Japanese physicians and developed a PSA training module. The aims of our study were to demonstrate the effectiveness of training and to describe PSA practice in Japan. Methods We undertook a pretest of PSA knowledge questions and a retest immediately after the training intervention. We also carried out a survey and asked about participants' PSA practice. The training module consisted of four didactic hours and three simulation and skills laboratory hours. Results of all pre‐ and post‐intervention knowledge questions were analyzed with McNemar's test, and overall scores were analyzed with a paired t‐test. Results One hundred and forty‐four health‐care providers including 123 physicians, 16 nurses, two pharmacists, and three medical students participated in the training. A total of 119 (83%) completed both the pre‐ and post‐intervention knowledge questions. Before the training, participants scored an average 66% (63%–69%) on the written knowledge test. After the intervention, participants showed significant improvement on the knowledge test (improvement 17%; 14%–20%). Among participants who answered the practice survey, 121 (88%) have undertaken PSA. Only 14 (12%) participants always or often use a continuous capnography for PSA. Only 32 (26.4%) participants undertook pre‐PSA systematic evaluation. Conclusion Our educational intervention successfully increased participants' knowledge. Only the minority of health‐care providers use capnography routinely for PSA, and pre‐PSA evaluation is not commonly carried out.

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Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel

Abstract: Non-anesthesia personnel can administer intravenous sedation for cardiac procedures in cardiac settings, with safety and cost-effectiveness demonstrated over many years. Anesthesia services are still appropriate for selected cases.

Cited by 36 publications

References 37 publications

2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion)

2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion)

CSANZ Position Statement on Sedation for Cardiovascular Procedures (2014)

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

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