Propofol sedation administered by cardiologists without assisted ventilation for long cardiac interventions: an assessment of 1000 consecutive patients undergoing atrial fibrillation ablation.

AIMS: Patients can expect a cure from atrial fibrillation (AF) with ablation. Procedural safety and success depend on patient comfort, compliance, and immobility. This is difficult to achieve with benzodiazepine and opiate boluses that are the mainstay of current practice. We sought to determine the safety and efficacy of propofol infusion sedation administered to patients without assisted ventilation for AF ablation. METHODS AND RESULTS: Procedural data from 1000 consecutive patients undergoing AF ablation were analysed. Sedation with 2% propofol was used in all procedures without assisted ventilation and was administered, monitored, and controlled by electrophysiologists. Primary outcome measures were adverse sedative affects including (i) respiratory depression (SpO(2)< 90% for >20 s) and (ii) persistent hypotension [systolic blood pressure (SBP)<90 mmHg at minimum sedation level]. Secondary endpoints included full recovery within 60 min and procedural complications. Of 1000 ablations, 506 ablations were performed for persistent and 494 for paroxysmal AF. Average patient age was 60.1 ± 11.3 years (72.3% male). Propofol was commenced in all patients at a mean infusion rate of 18.5 ± 4.8 mL/h with a mean baseline SBP of 140.3 ± 19.9 mmHg. Mean procedure time was 148.7 ± 57.7 min. Adverse sedative effects necessitating cessation of propofol and switch to midazolam bolus sedation occurred in 15.6% of patients (13.6% due to persistent hypotension, 1.9% due to respiratory depression, and 0.1% due to hypersalivation). Patients who had persistent hypotension were older (62.9 ± 11.2 vs. 60.0 ± 11.4 years, P= 0.011) and more likely to be female (39.5 vs. 23.7%, P< 0.001) than those who tolerated propofol. Patient age correlated to maximum blood pressure drop with propofol (R(2)= 0.101, P< 0.001) and inversely correlated to mean propofol infusion rate (R(2)= 0.066, P< 0.001). No procedures were abandoned due to adverse effects of sedation. All patients recovered within 60 min. Serious procedural complications, unrelated to sedation, occurred in 0.5%, all of whom had pericardial tamponade successfully treated with percutaneous pericardiocentesis. CONCLUSIONS: Sedation with 2% propofol infusion administered by cardiologists without assisted ventilation is safe, effective, and practical for use in AF ablation without serious or residual complications. In this setting, persistent hypotension is the most common acute adverse effect requiring cessation of propofol in ∼14%.

Nonparametric dark energy reconstruction from supernova data.

Understanding the origin of the accelerated expansion of the Universe poses one of the greatest challenges in physics today. Lacking a compelling fundamental theory to test, observational efforts are targeted at a better characterization of the underlying cause. If a new form of mass-energy, dark energy, is driving the acceleration, the redshift evolution of the equation of state parameter w(z) will hold essential clues as to its origin. To best exploit data from observations it is necessary to develop a robust and accurate reconstruction approach, with controlled errors, for w(z). We introduce a new, nonparametric method for solving the associated statistical inverse problem based on Gaussian process modeling and Markov chain Monte Carlo sampling. Applying this method to recent supernova measurements, we reconstruct the continuous history of w out to redshift z=1.5.

Verifying scientific simulations via comparative and quantitative visualization.

This article presents a visualization-assisted process that verifies scientific-simulation codes. Code verification is necessary because scientists require accurate predictions to interpret data confidently. This verification process integrates iterative hypothesis verification with comparative, feature, and quantitative visualization. Following this process can help identify differences in cosmological and oceanographic simulations.

Seeing the difference between cosmological simulations.

As cosmology simulations help us understand the universe, we must understand how the results of different simulations vary. Visualization and modern graphics hardware can now provide the ability to visually explore these differences interactively.

Inverse-scattering theory and the density perturbations from inflation.

We show how to use inverse-scattering theory as the basis for the inflationary reconstruction program, the goal of which is to gain information about the physics which drives inflation. Inverse-scattering theory provides an effective and well-motivated procedure, having a sound mathematical basis and being of sufficient generality that it can be considered the foundation for a nonparametric reconstruction program. We show how simple properties of the power spectrum translate directly into statements about the evolution of the background geometry during inflation.

The inflationary perturbation spectrum.

Motivated by the prospect of testing inflation from precision cosmic microwave background observations, we present analytic results for scalar and tensor perturbations in single-field inflation models, based on the application of uniform approximations. This technique is systematically improvable, possesses controlled error bounds, and does not rely on assuming the slow-roll parameters to be constant. We provide closed form expressions for the power spectra and the corresponding scalar and tensor spectral indices.

Nonlinear and nonequilibrium dynamics in geomaterials.

The transition from linear to nonlinear dynamical elasticity in rocks is of considerable interest in seismic wave propagation as well as in understanding the basic dynamical processes in consolidated granular materials. We have carried out a careful experimental investigation of this transition for Berea and Fontainebleau sandstones. Below a well-characterized strain, the materials behave linearly, transitioning beyond that point to a nonlinear behavior which can be accurately captured by a simple macroscopic dynamical model. At even higher strains, effects due to a driven nonequilibrium state, and relaxation from it, complicate the characterization of the nonlinear behavior.