Firme Elizabeth Bessadas Penna, Cavalcanti Ismar Lima, Barrucand Louis, Assad Alexandra Rezende, Figueiredo Nubia Verçosa
Post-Graduate Program in Surgical Sciences, Department of Surgery, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro – RJ, Brazil.
Rev Col Bras Cir. 2012 Dec;39(6):462-8. doi: 10.1590/s0100-69912012000600004.
To compare deep sedation with general anesthesia for curative ablation of atrial fibrillation.
We conducted a prospective, randomized study with 32 patients, aged between 18 and 65 years, ASA 2 and 3, BMI d" 30 kg/m2, divided into two groups: deep sedation (G1) and general anesthesia (G2). All patients received intravenous midazolam (0.5 mg / kg). G1 received propofol (1mg/kg) and O2 by facemask, followed by continuous infusion of propofol (25-50mg/kg/min) and remifentanil (0.01-0.05 mg / kg / min). G2 received propofol (2mg/kg) and laryngeal mask with built-in drain tube, followed by continuous infusion of propofol (60-100mg/kg/min) and remifentanil (0.06 to 0.1g/kg/min). We compared heart rate, invasive blood pressure, arterial blood gases, complications and recurrence (outcome) in three months.
G1 patients had arterial blood gas with higher PaCO2 levels and lower pH (p = 0.001) and higher incidence of cough. There was a decrease in Mean Arterial Pressure (MAP) and Heart Rate (HR) in G2. Except cough, complications and recurrence were similar in both groups.
Both techniques can be used for the curative ablation of atrial fibrillation. General anesthesia provided smaller respiratory changes and greater immobility of the patient.
比较深度镇静与全身麻醉用于房颤根治性消融术的效果。
我们进行了一项前瞻性随机研究，纳入32例年龄在18至65岁之间、ASA分级为2级和3级、BMI≤30kg/m²的患者，分为两组：深度镇静组（G1）和全身麻醉组（G2）。所有患者均静脉注射咪达唑仑（0.5mg/kg）。G1组患者面罩吸氧并静脉注射丙泊酚（1mg/kg），随后持续输注丙泊酚（25 - 50mg/kg/min）和瑞芬太尼（0.01 - 0.05mg/kg/min）。G2组患者静脉注射丙泊酚（2mg/kg）并置入带引流管的喉罩，随后持续输注丙泊酚（60 - 100mg/kg/min）和瑞芬太尼（0.06 - 0.1μg/kg/min）。我们比较了两组患者三个月内心率、有创血压、动脉血气、并发症及复发情况（结局）。
G1组患者动脉血气分析显示PaCO₂水平较高、pH较低（p = 0.001），咳嗽发生率较高。G2组平均动脉压（MAP）和心率（HR）下降。除咳嗽外，两组并发症及复发情况相似。
两种技术均可用于房颤根治性消融术。全身麻醉引起的呼吸变化较小，患者制动效果更佳。
