Anesthesia care for subcutaneous implantable cardioverter/defibrillator placement: a single-center experience.

Autor: Essandoh MK; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA. Electronic address: Michael.Essandoh@osumc.edu., Portillo JG; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Weiss R; Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus OH, USA., Otey AJ; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Zuleta-Alarcon AN; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Humeidan ML; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Torres JL; Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus OH, USA., Flores AS; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Castellon-Larios K; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Abdel-Rasoul M; Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus OH, USA., Andritsos MJ; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Perez WJ; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Stein EJ; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Turner KR; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Dimitrova GT; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Awad H; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Bhandary SP; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Tripathi RS; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Joseph NC; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus OH, USA., Hummel JD; Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus OH, USA., Augostini RS; Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus OH, USA., Kalbfleisch SJ; Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus OH, USA., Tyler JD; Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus OH, USA., Houmsse M; Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus OH, USA., Daoud EG; Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus OH, USA.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2016 Jun; Vol. 31, pp. 53-9. Date of Electronic Publication: 2016 Mar 22.
DOI: 10.1016/j.jclinane.2015.11.009
Abstrakt: 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.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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