EVALUATION OF THE SAFETY AND EFFICACY OF DEEP SEDATION FOR ELECTROPHYSIOLOGY PROCEDURES ADMINISTERED IN THE ABSENCE OF AN ANESTHETIST

Several procedures performed in the electrophysiology laboratory (EP l ab) require surgical manipulation and are lengthy, Patients undergoing such procedures usually receive general anesthesia or deep sedation a dministered by an anesthesiologist. In 536 consecutive procedures perf ormed in the EP lab, we assessed the safety and efficacy of deep sedat ion administered under the direction of an electrophysiologist and in the absence of an anesthetist. Patients were monitored with pulse oxim etry, noninvasive blood pressure recordings, and continuous ECGs. The level of consciousness and vital signs were evaluated at 5-minute inte rvals. Deep sedation was induced in 260 patients using midazolam, phen ergan, and meperidine, then maintained with intermittent dosing of mep eridine at the following mean doses: midazolam 0.031 +/- 0.024 mg/kg; phenergan 0.314 +/- 0.179 mg/kg; and meperidine 0.391 +/- 0.167 mg/kg per hour. In the remaining 276 patients, deep sedation was induced wit h midazolam and fentanyl and maintained with a continuous infusion of fentanyl at a mean dose of 2.054 +/- 1.43 mu g/kg per hour. Fourteen p atients experienced a transient reduction in oxygen saturation that wa s readily reversed following administration of naloxone. An additional 11 patients desaturated secondary to partial airway obstruction, whic h resolved after repositioning the head and neck. Fourteen patients ex perienced hypotension with fentanyl. All but one returned to baseline blood pressures following an infusion of normal saline. No patient req uired intubation and no death occurred. Only three patients had recoll ection of periprocedure events. No patient remembered experiencing pai n with the procedure. Hospital stays were not prolonged as a result of the sedation used. In conclusion: (1) deep sedation during EP procedu res can be administered safely under the guidance of the electrophysio logist without an anesthetist present; (2) the drugs used should be re adily reversible in case of respiratory depression; and (3) this appro ach may reduce the overall cost of the procedures in the EP lab, maint aining adequate patient comfort.