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. 2015 Jul 29;15(2):96-102.
doi: 10.1016/j.ipej.2015.07.003. eCollection 2015 Mar-Apr.

Anesthetic management in atrial fibrillation ablation procedure: Adding non-invasive ventilation to deep sedation

Francesco Sbrana  1 , Andrea Ripoli  1 , Bruno Formichi  2
Affiliations

Anesthetic management in atrial fibrillation ablation procedure: Adding non-invasive ventilation to deep sedation

Francesco Sbrana et al. Indian Pacing Electrophysiol J. .

Abstract

Anesthetic management of patients undergoing pulmonary vein isolation for atrial fibrillation has specific requirements. The feasibility of non-invasive ventilation (NIV) added to deep sedation procedure was evaluated. Seventy-two patients who underwent ablation procedure were retrospectively revised, performed with (57%) or without (43%) application of NIV (Respironic(®) latex-free total face mask connected to Garbin ventilator-Linde Inc.) during deep sedation (Midazolam 0.01-0.02 mg/kg, fentanyl 2.5-5 μg/kg and propofol: bolus dose 1-1.5 mg/kg, maintenance 2-4 mg/kg/h). In the two groups (NIV vs deep sedation), differences were detected in intraprocedural (pH 7.37 ± 0.05 vs 7.32 ± 0.05, p = 0.001; PaO2 117.10 ± 27.25 vs 148.17 ± 45.29, p = 0.004; PaCO2 43.37 ± 6.91 vs 49.33 ± 7.34, p = 0.002) and in percentage variation with respect to basal values (pH -0.52 ± 0.83 vs -1.44 ± 0.87, p = 0.002; PaCO2 7.21 ± 15.55 vs 34.91 ± 25.76, p = 0.001) of arterial blood gas parameters. Two episodes of respiratory complications, treated with application of NIV, were reported in deep sedation procedure. Endotracheal intubation was not necessary in any case. Adverse events related to electrophysiological procedures and recurrence of atrial fibrillation were recorded, respectively, in 36% and 29% of cases. NIV proved to be feasible in this context and maintained better respiratory homeostasis and better arterial blood gas balance when added to deep sedation.

Keywords: Anesthesiological management; Atrial fibrillation; Deep sedation; Non-invasive ventilation.

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Figures

Fig. 1
Fig. 1
Patients flow diagram of the study.
Fig. 2
Fig. 2
Intra-procedural differences in arterial blood gas variables.
Fig. 3
Fig. 3
Intra-procedural changes in arterial blood gas variables (percentage variation compared to basal values).
See this image and copyright information in PMC

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