Thomas Stuart P, Thakkar Jay, Kovoor Pramesh, Thiagalingam Aravinda, Ross David L
Department of Cardiology, Westmead Hospital and University of Sydney, Sydney, NSW, Australia.
Pacing Clin Electrophysiol. 2014 Jun;37(6):781-90. doi: 10.1111/pace.12370. Epub 2014 Feb 20.
Administration of intravenous sedation (IVS) has become an integral component of procedural cardiac electrophysiology. IVS is employed in diagnostic and ablation procedures for transcutaneous treatment of cardiac arrhythmias, electrical cardioversion of arrhythmias, and the insertion of implantable electronic devices including pacemakers, defibrillators, and loop recorders. Sedation is frequently performed by nursing staff under the supervision of the proceduralist and in the absence of specialist anesthesiologists. The sedation requirements vary depending on the nature of the procedure. A wide range of sedation techniques have been reported with sedation from the near fully conscious to levels approaching that of general anesthesia. This review examines the methods employed and outcomes associated with reported sedation techniques. There is a large experience with the combination of benzodiazepines and narcotics. These drugs have a broad therapeutic range and the advantage of readily available reversal agents. More recently, the use of propofol without serious adverse events has been reported. The results provide a guide regarding the expected outcomes of these approaches. The complication rate and need for emergency assistance is low in reported series where sedation is administered by nonspecialist anesthesiology staff.
静脉镇静（IVS）的应用已成为心脏程序性电生理学不可或缺的一部分。IVS用于经皮治疗心律失常、心律失常的电复律以及植入包括起搏器、除颤器和环路记录器在内的植入式电子设备的诊断和消融手术。镇静通常由护理人员在手术医生的监督下进行，且无需专业麻醉医生在场。镇静需求因手术性质而异。据报道，镇静技术种类繁多，从接近完全清醒到接近全身麻醉的水平都有。本综述探讨了所采用的方法以及与报道的镇静技术相关的结果。苯二氮䓬类药物与麻醉药品联合使用已有大量经验。这些药物具有广泛的治疗范围，且有易于获得的逆转剂这一优势。最近，有报道称使用丙泊酚未出现严重不良事件。研究结果为这些方法的预期结果提供了指导。在由非专业麻醉人员实施镇静的报道系列中，并发症发生率和紧急援助需求较低。
