Propofol for sedation for direct current cardioversion

Abstract

Direct current cardioversion is a low-risk and standard procedure to restore normal sinus rhythm in patients with tachyarrhythmias. It requires sedation to facilitate the procedure, as it is painful and distressful. The preferred anesthetic drug must be short acting, producing conscious sedation, to enable rapid recovery after the procedure. In this sense, this narrative review focuses on the critical analysis of recent randomized studies and presents about the safety and effectiveness of propofol, comparing it with other established sedatives, mainly etomidate and midazolam. The research was performed on MEDLINE database with Propofol and Cardioversion keywords. In most cases, propofol comes to be the best option, with a quick recovery time and low rates of side effects. Different studies have demonstrated no inferiority when comparing to other drugs and, when these adverse events happened, they were easily and quickly handled. Exceptions in this scenario are those patients, particularly the elderly, with baseline important structural heart disease, in which etomidate with fentanyl has been pointed to lead to better hemodynamic stability.

Effectiveness of a simple medication adjustment protocol for optimizing peri-cardioversion rate control: A derivation and validation cohort study

“…Propofol was most commonly used owing to its safety profile in elective DCCV. 16 Its rapid onset and offset is unlikely to contribute to profound sustained bradycardia.…”

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

“… 422 O melhor esquema anestésico deve promover o menor grau de depressão miocárdica e de vasodilatação possível. Todo anestésico inalatório e a maioria dos anestésicos venosos são depressores do miocárdio, 912 necessitando de titulação e monitorização criteriosa por parte do anestesista. Sempre que possível, conforme o tipo de cirurgia, técnicas de anestesia regional isoladamente ou em associação com a anestesia geral devem ser utilizadas por apresentarem menor risco de instabilidade hemodinâmica.…”

“… 422 The best anesthetic regimen should cause the lowest possible grade of myocardial depression and vasodilation. All inhalation anesthetics and most venous anesthetics are myocardial depressant drugs, 912 requiring titration and judicious monitoring by the anesthesiologist. Whenever possible, according to the surgery type, regional anesthesia techniques should be used isolated or associated with general anesthesia due to the lower risk of hemodynamic instability.…”

Acute Renal Failure and Hemolytic Anemia After Electrical Cardioversion In A Patient With Paroxysmal Atrial Fibrillation.

“…It is a safe, effective, and reliable method for aborting Afib, especially in unstable situations [5]. Direct EC is superior to pharmacologic conversion because of its shorter overall procedure duration, higher success rate, and lower risk of proarrhythmic [6,7].…”