A critical role for sedation.

By 2020, traditional cardiovascular surgeries will make up a quarter of cardiac interventions worldwide, while interventional procedures such as catheterizations, ablation, and cardioversion therapy will make up the majority.([FOOTNOTE= Joshi B. Cardiovascular Surgical Devices: Technologies and Global Markets. BCC Research. 2016; Report ID: HLC076C. Retrieved April 13, 2017 from View Abstract.],[ANCHOR=],[LINK=https://www.bccresearch.com/market-research/healthcare/cardiovascular-surgical-devices-markets-report-hlc076c.html]) Monitoring sedation for the patients having these procedures will be key to keeping them safe and comfortable.

Sedation in the Cardiac Cath Lab

Ensuring adequate respiration and ventilation

Careful sedative selection, along with pulse oximetry and capnography monitoring, can help reduce respiratory depression and help identify it when it occurs.2

Balancing discomfort and procedure length

70% judged procedure “very good” with deep sedation.([FOOTNOTE=Münkler P, Attanasio P, Parwani AS, Huemer M, Boldt LH, Haverkamp W, Wutzler A. High Patient Satisfaction with Deep Sedation for Catheter Ablation of Cardiac Arrhythmia. Pacing Clin Electrophysiol. 2017.],[ANCHOR=],[LINK=])

23% judged procedure “good” with deep sedation.

Minimal sedation has been proven to work for cardiac ablation procedures, which can be painful. Deep sedation — though it results in longer procedures — doesn’t result in more complications or sedation effects.([FOOTNOTE=Wutzler A, Mueller A, Loehr L, Huemer M, Parwani AS, Attanasio P, Blaschke F, Storm C, Boldt LH, Haverkamp W. Minimal and deep sedation during ablation of ventricular tachycardia. Int J Cardiol. 2014;172(1):161-4.],[ANCHOR=],[LINK=])  Patients have also reported satisfaction with deep sedation.7

Alternatives for high-risk populations

91 vs. 155 minutes median procedure duration, monitored anesthesia care vs. general anesthesia.

T-AVR has resulted in significantly shorter procedure times and shorter ICU and hospital length of stay, while no significant difference was seen in three-month and one-year mortality rates.4,5

Ensuring Satisfaction

In one study, relatively mild doses of a sedative/analgesic drug combination appeared to lower the frequency of arterial spasms, as well as reduce side effects. Patients receiving the treatment reported significantly less discomfort than the control group.6

Anxiety – A continuing sedation challenge

Anxiety can have harmful effects on compromised cardiovascular function by increasing heart rate and blood pressure. Anxiety may interfere with the patient's ability to cooperate during a procedure.([FOOTNOTE=Gallagher R, Trotter R, Donoghue J. Preprocedural Concerns and Anxiety Assessment in Patients Undergoing Coronary Angiography and Percutaneous Coronary Interventions. Eur J Cardiovasc Nurs. 2010;9(1):38-44.],[ANCHOR=],[LINK=]) Clinicians take patients' anxiety levels into account when determining appropriate sedatives and sedation levels.([FOOTNOTE=Buzatto LL, Zanei SSV. Patients' anxiety before cardiac catheterization. Einstein (Sao Paulo). 2010;8(4):483-487. doi: 10.1590/S1679-45082010RW1517.],[ANCHOR=],[LINK=])

To address sedation challenges, the British Cardiovascular Society recommends capnography as an element of safe sedation practice.([FOOTNOTE=Furniss SS, Sneyd JR. Safe sedation in modern cardiological practice. Heart. 2015;101(19):1526-1530. doi: 10.1136/heartjnl-2015-307656.],[ANCHOR=],[LINK=])

  • 12. Guerra F, Pavoni I, Romandini A, et al. Feasibility of a cardiologist-only approach to sedation for electrical cardioversion of atrial fibrillation: a randomized, open-blinded, prospective study. Int J Cardiol. 2014;176(3):930-4.