Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel.
J Interv Card Electrophysiol
; 21(1): 43-51, 2008 Jan.
Article
em En
| MEDLINE
| ID: mdl-18273696
ABSTRACT
AIMS:
Primary to determine the safety and efficacy of intravenous sedation for cardiac procedures administered by non-anesthesia personnel. Secondary to assess cost effectiveness of such sedation.METHODS:
Anesthesiologists trained non-anesthesia personnel, and established our sedation protocol, which was then used in 9,558 patients who had cardiac procedures with sedation by non-anesthesia personnel, recorded on a computerized database. Most sedation used was midazolam (MID) and morphine (MOR). Complications and problems were derived from the database and quality assurance committee records. Doses were based on desired level of sedation and procedure duration; highest dose used MID 78 mg, MOR 84 mg.RESULTS:
Data included catheterization (n = 3,819) and transesophageal echo procedures (n = 260); and overall electrophysiology (n = 5,479) and selected subsets. There were complications or problems in only 9 patients (0.1%), a strong safety statement. There were 3 deaths in electrophysiology related procedures, 2 deaths in catheterization related procedures, all in very sick patients and not definitely related to sedation; 4 others developed clinical instability (hives, hypotension and heart failure-all with no sequellae), 2 of which needed reversal medications. Three patients (<0.03%) proved difficult to sedate, and their procedures were completed with help from the anesthesia department; by protocol this was not a complication. A total of $5,365,691 was saved during the last decade on cardiac procedures performed with conscious sedation.CONCLUSION:
Non-anesthesia personnel can administer intravenous sedation for cardiac procedures in cardiac settings, with safety and cost-effectiveness demonstrated over many years. Anesthesia services are still appropriate for selected cases.
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Midazolam
/
Medição de Risco
/
Pessoal Técnico de Saúde
/
Procedimentos Cirúrgicos Cardíacos
/
Hipnóticos e Sedativos
/
Anestesia Geral
/
Morfina
Tipo de estudo:
Etiology_studies
/
Guideline
/
Health_economic_evaluation
/
Observational_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Interv Card Electrophysiol
Assunto da revista:
CARDIOLOGIA
Ano de publicação:
2008
Tipo de documento:
Article
País de afiliação:
Estados Unidos