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

Elif Kaya, Hendrik Südkamp, Julia Lortz, Tienush Rassaf, Rolf Alexander Jánosi, Elif Kaya, Hendrik Südkamp, Julia Lortz, Tienush Rassaf, Rolf Alexander Jánosi

Abstract

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.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Mean dosages of propofol, midazolam, and fentanyl used during noncomplex and complex procedures. The error bars represent the standard error of the mean (2 SE). *p 

Figure 2

Procedural details for noncomplex and…

Figure 2

Procedural details for noncomplex and complex cardiac implantable electronic device procedures. Despite a…

Figure 2
Procedural details for noncomplex and complex cardiac implantable electronic device procedures. Despite a significantly longer procedure time and significantly lower ejection fraction (EF) in the complex group, the minimal mean arterial pressure (MAP) and postoperative stay are comparable between the two groups. The error bars represent the standard error of the mean (2 SE). *p 
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Figure 2
Figure 2
Procedural details for noncomplex and complex cardiac implantable electronic device procedures. Despite a significantly longer procedure time and significantly lower ejection fraction (EF) in the complex group, the minimal mean arterial pressure (MAP) and postoperative stay are comparable between the two groups. The error bars represent the standard error of the mean (2 SE). *p 

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