SAFETY OF NURSE-ADMINISTERED DEEP SEDATION FOR DEFIBRILLATOR IMPLANTATION IN THE ELECTROPHYSIOLOGY LABORATORY

Implantation of implantable cardioverter defibrillators (ICDs) in the electrophysiology (EP) laboratory has been shown to be safe. However, general endotracheal anesthesia and/or administration of sedatives is mostly performed by anesthesiologists. In 53 patients undergoing ICD i mplantation in the EP laboratory, we prospectively assessed whether de ep sedation without endotracheal intubation can be administered by nur sing personnel under medical supervision, The mean patient age was 67 +/- 7 years, and the mean ejection fraction was 32 +/- 8%. All ICDs we re placed in the abdomen requiring lead tunneling, Patients were monit ored with pulse oximetry and noninvasive blood pressure recordings. Th e level of consciousness and vital signs were evaluated at 5-minute in tervals, Deep sedation was induced with phenergan and midazolam and ma intained with either meperidine or fentanyl. The mean doses given were as follows: phenergan 0.33 +/- 0.15 mg/kg, midazolam 0.05 +/- 0.03 mg /kg, meperidine 0.46 +/- 0.10 mg/kg per hour, and fentanyl 1.94 +/- 0. 71 mu g/kg per hour. None of the patients required intubation during o r after the procedure, No death occurred and no patient had any recoll ection of the procedure. In three patients, O-2 desaturation was easil y managed by transient reversion of the effects of meperidine or fenta nyl with naloxone, No patient experienced prolonged hospitalization af ter the implant (mean 2.4 +/- 0.5 days). In conclusion: (1) adequate s edation for ICD implantation and testing can be administered safely by nursing staff in the EP lab; (2) optimum sedation protocols should in clude drugs easy to reverse in case of excessive respiratory depressio n; and (3) this may represent a more cost-effective approach to ICD im plantation.