Procedural sedation with dexmedetomidine during ablation of atrial fibrillation: a randomized controlled trial

Abstract

Procedural sedation with dexmedetomidine may assure safety and patient immobility during AF ablation, and therefore may be a potential alternative for that with GABAergic anaesthetics.

Intraoperative Dexmedetomidine Improves the Quality of Recovery and Postoperative Pulmonary Function in Patients Undergoing Video-assisted Thoracoscopic Surgery

“…14 It is also used for sedation in the intensive care unit. Recently, it was reported that dexmedetomidine is often used as an adjuvant for general anesthesia.…”

Recent Trends in the Practice of Procedural Sedation Under Local Anesthesia for Catheter Ablation, Gastrointestinal Endoscopy, and Endoscopic Surgery in Japan: A Retrospective Database Study in Clinical Practice from 2012 to 2015

“…Irrespective of this compromise, the pattern of complications did not deviate largely from the safety profile of the sedatives that were commonly used for each procedure. For example, DEX induces sedation by sympatholytic effects through stimulation of α 2A -adrenoceptors in the locus ceruleus, resulting in a minimized risk for respiratory depression to a greater extent than other sedatives, including PF [21], MDZ [21, 24], and TIA [25]. By increasing parasympathetic activity, however, DEX induces bradycardia.…”

Sedation in the Electrophysiology Laboratory: A Multidisciplinary Review

“…However, there was significantly more hypotension at 60 and 120 minutes in the dexmedetomidine–remifentanil group. The second trial by Sairaku et al randomized 87 patients to dexmedetomidine with rescue thiamylal (a barbiturate) versus thiamylal only targeting moderate sedation using a PDNA model; both groups also received pentazocine (an opioid analgesic). The incidence of hypotension and bradycardia were similar between groups.…”

“…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.…”

“…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, 2 yet there is also ample literature espousing the safety and benefits of PDNA sedation for these cases. [3][4][5][6][7] Moreover, intended sedation plans may require modification over the course of a procedure. A 2-year review of 208 adults undergoing catheter ablation (including for supraventricular tachycardia, atrial tachycardia, atrial flutter, premature ventricular contraction, and ventricular tachycardia) using a variety of sedation strategies demonstrated that of the 186 non-GA cases, 20 required conversion to GA and 54 needed additional airway interventions.…”