Anesthesia care for subcutaneous implantable cardioverter/defibrillator placement: a single-center experience - 14/05/16
, Juan G. Portillo, MD a, Raul Weiss, MD b, Andrew J. Otey, BS a, Alix N. Zuleta-Alarcon, MD a, Michelle L. Humeidan, MD, PhD a, Jose L. Torres, MD b, Antolin S. Flores, MD a, Karina Castellon-Larios, MD a, Mahmoud Abdel-Rasoul, MS, MPH c, Michael J. Andritsos, MD a, William J. Perez, MD a, Erica J. Stein, MD a, Katja R. Turner, MD a, Galina T. Dimitrova, MD a, Hamdy Awad, MD a, Sujatha P. Bhandary, MD a, Ravi S. Tripathi, MD a, Nicholas C. Joseph a, John D. Hummel, MD b, Ralph S. Augostini, MD b, Steven J. Kalbfleisch, MD b, Jaret D. Tyler, MD b, Mahmoud Houmsse, MD b, Emile G. Daoud, MD bAbstract |
Background |
The recently approved subcutaneous implantable cardioverter/defibrillator (S-ICD) uses a single extrathoracic subcutaneous lead to treat life-threatening ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation. This is different from conventional transvenous ICDs, which are typically implanted under sedation. Currently, there are no reports regarding the anesthetic management of patients undergoing S-ICD implantation.
Study objectives |
This study describes the anesthetic management and outcomes in patients undergoing S-ICD implantation and defibrillation threshold (DFT) testing.
Methods |
The study population consists of 73 patients who underwent S-ICD implantation. General anesthesia (n = 69, 95%) or conscious/deep sedation (n = 4, 5%) was used for device implantation.
Measurements |
Systolic blood pressure (SBP) and heart rate were recorded periprocedurally for S-ICD implantation and DFTs. Major adverse events were SBP <90 mm Hg refractory to vasopressor agents, significant bradycardia (heart rate <45 beats per minute) requiring pharmacologic intervention and, “severe” pain at the lead tunneling site and the S-ICD generator insertion site based on patient perception.
Interventions |
Of the 73 patients, 39 had SBP <90 mm Hg (53%), and intermittent boluses of vasopressors and inotropes were administered with recovery of SBP. In 2 patients, SBP did not respond, and the patients required vasopressor infusion in the intensive care unit.
Main results |
Although the S-ICD procedure involved extensive tunneling and a mean of 2.5 ± 1.7 DFTs per patient, refractory hypotension was a major adverse event in only 2 patients. The mean baseline SBP was 132.5 ± 22.0 mm Hg, and the mean minimum SBP during the procedure was 97.3 ± 9.2 mm Hg (P < .01). There was also a mean 13–beats per minute decrease in heart rate (P < .01), but no pharmacologic intervention was required. Eight patients developed “severe” pain at the lead tunneling and generator insertion sites and were adequately managed with intravenous morphine.
Conclusions |
Among a heterogeneous population, anesthesiologists can safely manage patients undergoing S-ICD implantation and repeated DFTs without wide swings in SBP and with minimal intermittent pharmacologic support.
Le texte complet de cet article est disponible en PDF.Highlights |
• | S-ICD implantation and testing can be safely performed under general anesthesia. |
Keywords : Defibrillation threshold testing, General anesthesia, Subcutaneous implantable cardioverter/defibrillator, Transvenous implantable cardioverter/defibrillator
Plan
| ☆ | Disclosures: In the past, Dr Raul Weiss has received advisory and speaker honoraria from Cameron Health, Inc, San Clemente, CA (modest relationship). The Ohio State University Wexner Medical Center EP section receives funding for partial support of a single EP fellowship training grant from Boston scientific. Funding and resources for the execution of this project were provided by the Department of Anesthesiology, The Ohio State University Wexner Medical Center, 410 W 10th Ave N-411 Doan Hall, Columbus, OH 43210. |
| ☆☆ | Summary statement: This study demonstrates that among a heterogeneous population with multiple cardiovascular comorbidities undergoing implantation and repeated testing of a subcutaneous implantable cardioverter/defibrillator, anesthesiologists can safely provide care without wide hemodynamic swings and with intermittent pharmacologic support. |
| ★ | Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. |
Vol 31
P. 53-59 - juin 2016 Retour au numéro
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