Sedation and analgesia in the cardiac electrophysiology laboratory: A national survey of electrophysiologists investigating the who, how, and why?

Brantley Dollar Gaitan, Terrence L. Trentman, Sharon L. Fassett, Jeff T. Mueller, Gregory T. Altemose

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective To investigate sedation and anesthesia trends and practice patterns for procedures in the cardiac electrophysiology laboratory (EPL). Design A survey distributed by e-mail. Setting US teaching hospitals with a training program in cardiac electrophysiology. Participants Cardiologists involved in procedures in the electrophysiology laboratory of academic electrophysiology programs. Interventions A survey was e-mailed to the selected programs. The survey questions included the use of anesthesia professional (MD/CRNA) and nonanesthesia professional (RN) services, medications administered, commonly performed airway interventions, satisfaction with anesthesia services, and reasons that anesthesia professionals are not used when RNs administer sedation. Measurements and Main Results Of the 95 academic electrophysiology programs surveyed, there were 38 responses (40%). The majority (71%) of respondents used a combined model of care with both anesthesia professional care and nonanesthesia professional (RN) sedation, although there were EPLs that had exclusively anesthesia professional (n = 6) and exclusively nonanesthesia professional coverage (n = 5); 26.3% of respondents answered that care by an anesthesia professional was warranted most (>50%) of the time regardless of their current care model. The main reasons cited for having RN-administered sedation were the lack of availability of anesthesia professionals, difficulty with scheduling, and increased operating room suite turnover times. Programs using exclusively RN sedation (13%) reported all levels of anesthesia including general anesthesia (patient unarousable to repeated deep stimulation). Conclusions This survey suggested that sedation for EPL procedures was sometimes allowed to progress to deep sedation and general anesthesia and that selection of anesthesia provider frequently was made based on availability, operating room efficiency, and economic reasons before patient safety issues. The implications of the survey must be explored further in a larger-scale sample population before more definitive statements can be made, but results suggested that sedation in the EPL is an area that would benefit from updated guidelines specific to the current practice as well as attention from the anesthesia community to address the deficiency in provision of anesthesia care.

Original languageEnglish (US)
Pages (from-to)647-659
Number of pages13
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume25
Issue number4
DOIs
StatePublished - Aug 2011

Fingerprint

Cardiac Electrophysiology
Analgesia
Anesthesia
Electrophysiology
Operating Rooms
General Anesthesia
Surveys and Questionnaires
Deep Sedation
Postal Service
Patient Safety
Teaching Hospitals

Keywords

  • analgesia
  • anesthesia
  • electrophysiologic procedures
  • electrophysiology laboratory
  • sedation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Sedation and analgesia in the cardiac electrophysiology laboratory : A national survey of electrophysiologists investigating the who, how, and why? / Gaitan, Brantley Dollar; Trentman, Terrence L.; Fassett, Sharon L.; Mueller, Jeff T.; Altemose, Gregory T.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 25, No. 4, 08.2011, p. 647-659.

Research output: Contribution to journalArticle

Gaitan, Brantley Dollar ; Trentman, Terrence L. ; Fassett, Sharon L. ; Mueller, Jeff T. ; Altemose, Gregory T. / Sedation and analgesia in the cardiac electrophysiology laboratory : A national survey of electrophysiologists investigating the who, how, and why?. In: Journal of Cardiothoracic and Vascular Anesthesia. 2011 ; Vol. 25, No. 4. pp. 647-659.
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abstract = "Objective To investigate sedation and anesthesia trends and practice patterns for procedures in the cardiac electrophysiology laboratory (EPL). Design A survey distributed by e-mail. Setting US teaching hospitals with a training program in cardiac electrophysiology. Participants Cardiologists involved in procedures in the electrophysiology laboratory of academic electrophysiology programs. Interventions A survey was e-mailed to the selected programs. The survey questions included the use of anesthesia professional (MD/CRNA) and nonanesthesia professional (RN) services, medications administered, commonly performed airway interventions, satisfaction with anesthesia services, and reasons that anesthesia professionals are not used when RNs administer sedation. Measurements and Main Results Of the 95 academic electrophysiology programs surveyed, there were 38 responses (40{\%}). The majority (71{\%}) of respondents used a combined model of care with both anesthesia professional care and nonanesthesia professional (RN) sedation, although there were EPLs that had exclusively anesthesia professional (n = 6) and exclusively nonanesthesia professional coverage (n = 5); 26.3{\%} of respondents answered that care by an anesthesia professional was warranted most (>50{\%}) of the time regardless of their current care model. The main reasons cited for having RN-administered sedation were the lack of availability of anesthesia professionals, difficulty with scheduling, and increased operating room suite turnover times. Programs using exclusively RN sedation (13{\%}) reported all levels of anesthesia including general anesthesia (patient unarousable to repeated deep stimulation). Conclusions This survey suggested that sedation for EPL procedures was sometimes allowed to progress to deep sedation and general anesthesia and that selection of anesthesia provider frequently was made based on availability, operating room efficiency, and economic reasons before patient safety issues. The implications of the survey must be explored further in a larger-scale sample population before more definitive statements can be made, but results suggested that sedation in the EPL is an area that would benefit from updated guidelines specific to the current practice as well as attention from the anesthesia community to address the deficiency in provision of anesthesia care.",
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