Conscious sedation during subcutaneous implantable cardioverter-defibrillator implantation using the intermuscular technique.

BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) system is an established therapy for the prevention of sudden cardiac death (SCD) and an alternative to a transvenous implantable cardioverter-defibrillator (ICD) system in selected patients. S-ICDs are usually implanted under general anesthesia. The purpose of the present study was to describe the technical feasibility and safety of local anesthesia with conscious sedation as an alternative to general anesthesia during S-ICD implantation using the intermuscular technique. METHODS: We conducted a retrospective, single-center study on patients undergoing S-ICD implantation using the intermuscular technique at our center between February 2016 and May 2018. All procedures were performed under controlled sedation with propofol and midazolam. Local anesthesia was used for all procedures. RESULTS: Twenty-two patients (17 men and 5 women) with a mean age of 51.1 ± 16.2 years were included. The indication for S-ICD implantation was primary prevention in 18 (81.8%) patients. The mean dose of midazolam and propofol administered was 7.8 ± 2.3 mg and 72.7 ± 37.4 mg, respectively. The procedural success rate was 100%, with no apneic or hypoxic episodes or other complications requiring therapeutic intervention. None of the patients required conversion to general anesthesia. All patients were comfortable with the position and appearance of the device. CONCLUSIONS: Our findings suggest that local anesthesia with conscious sedation using propofol and midazolam is a safe and feasible option for S-ICD implantation procedures using an intermuscular technique.

Feasibility and safety of using local anaesthesia with conscious sedation during complex cardiac implantable electronic device procedures.

We assessed the feasibility and safety of using local anaesthesia with conscious sedation as an alternative to general anaesthesia during complex and noncomplex cardiac implantable device procedures. We enrolled 279 consecutive patients who underwent cardiac device implantation/replacement at our tertiary/quaternary cardiac specialist hospital during a 17-month study period. Continuous combined intravenous conscious sedation with propofol and midazolam plus fentanyl and local anaesthesia were used for all procedures. Among the patients, 113, 59, 43, and 64 patients underwent pacemaker implantation, implantable cardiac defibrillator implantation, cardiac resynchronisation therapy device implantation, and generator exchange, respectively. The procedural success rate was 100%, with no apnoea or hypoxia episodes requiring therapeutic intervention. None of the patients required conversion to general anaesthesia. The mean surgical duration was longer for complex vs. noncomplex procedures (p = 0.003). The minimum mean arterial pressure during complex procedures was slightly lower than that during noncomplex procedures (p = 0.03). The perioperative (<24 h) mortality rate was 0%, and neither complexity group required tracheal intubation. Only two patients (0.7%) required unplanned intensive care unit admission for further surveillance. Our findings suggest that local anaesthesia with conscious sedation is a safe and feasible option for cardiac device implantation procedures, including complex procedures.

Therapeutic effects of intralipid and medialipid emulsionsin a rat model of verapamil toxicity.

BACKGROUND/AIM: Lipid emulsions are promising as a potential new therapy for severe verapamil overdose. Our purpose is to draw attention to the choice of solution by investigating the efficacy of intralipid 20% or medialipid 20% in verapamil overdose. MATERIALS AND METHODS: Eighteen adult Sprague Dawley rats were randomly divided into three groups: control (saline; Group C), intralipid 20% (Group I), and medialipid 20% (Group M). Rats were anesthetized with ketamine. Blood gas analysis, baseline heart rate (HRb), and mean arterial pressure (MAPb) were evaluated. Verapamil at 2.5 mg kg-1 min-1 was infused until the HRb and MAPb decreased by 50% and the times to HR0 and MAP0 were recorded. Treatment solutions of the groups were administered as 12.4 mL kg-1 in 5 min. RESULTS: While HR did not show a difference, MAP showed statistically significant differences among the groups. Intralipid 20% was more efficient than the other two treatments at an early stage; however, as the administration time progressed, medialipid 20% also turned out to be more efficient than the control treatment. CONCLUSION: Our findings indicate that in a toxicity model of rats produced with verapamil, intralipid 20% and medialipid 20% solutions partially eliminate cardiac-depressant effects and increase the survival rate.

Isofuranodiene: A neuritogenic compound isolated from wild celery (Smyrnium olusatrum L., Apiaceae).

In the search for neuroactive compounds that mimic the nerve growth factor (NGF) activity for the protection against neurodegenerative diseases, the potential medicinal values of foods and plants attracts intense interest. Isofuranodiene is the major constituent of the essential oil of wild celery (Smyrnium olusatrum L., Apiaceae). The cytotoxic effects of isofuranodiene towards rat neuronal PC-12 pheochromocytoma cells were determined by MTT assay, while the cell differentiation was evaluated with xCELLigence real time cell analysis system (RTCA DP), and the neuritogenic activity was assessed by neurite outgrowth image analysis. Isofuranodiene at concentrations of 25 and 12.5 µM alone, or in combination with 50 nM NGF, showed a marked stimulation of neuritogenesis, but it was more effective at 12.5 µM with or without NGF. The present study reports the first evidence of the neuritogenic effects of isofuranodiene, which appears to be a promising neurotrophic and neuroprotective agent deserving further investigation.