Peyrol Michaël, Barraud Jérémie, Cautela Jennifer, Maille Baptiste, Laine Marc, Bonello Laurent, Thuny Franck, Paganelli Franck, Franceschi Frédéric, Koutbi Linda, Levy Samuel
Assistance Publique-Hôpitaux de Marseille (APHM), Department of Cardiology, Nord Hospital, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France.
J Interv Card Electrophysiol. 2017 Aug;49(2):191-196. doi: 10.1007/s10840-017-0255-5. Epub 2017 May 23.
Subcutaneous implantable cardioverter defibrillator (S-ICD) is an alternative to transvenous ICD to prevent sudden cardiac death. Subcutaneous ICD implantation frequently requires general anesthesia because of procedure nociceptive steps during creation of a large device pocket and lead tunneling. This study aims to determine if a strategy of operator-guided controlled sedation with midazolam and analgesia with nalbuphine is effective in alleviating pain during S-ICD implantation.
This prospective study included consecutive patients undergoing S-ICD implantation under controlled sedation with midazolam and combined analgesia with nalbuphine. The Critical-Care Pain Observation Tool (CPOT), a behavioral pain scale, was used for pain assessment during S-ICD placement and the Numeric Rate Scale (NRS) was used for evaluation of pain recollection after patient recovery. CPOT score of 3 or above and NRS score of 4 or above are considered to be associated with significant pain.
Sixteen patients were included in this study: Ten men (62.5%) and six women with a mean age of 54 ± 11 years. Indication for S-ICD implantation was primary prevention in 11 patients (68.8%). Mean dose of administrated midazolam and nalbuphine was 0.11 ± 0.03 and 0.27 ± 0.05 mg/kg, respectively. Mean CPOT during the whole procedure was 1.4 ± 1.6. No patient presented procedural pain recollection as all 16 patients had NRS score less than 4. No serious adverse event related to sedation occurred during S-ICD implantation.
This study suggests that operator-guided controlled sedation with midazolam and analgesia with nalbuphine is effective to alleviate procedural pain in patients undergoing S-ICD implantation and may constitute an alternative to general anesthesia.
皮下植入式心律转复除颤器（S-ICD）是经静脉植入式心律转复除颤器之外预防心源性猝死的另一种选择。由于在制作较大的设备囊袋和导线隧道过程中存在手术伤害性步骤，皮下植入式心律转复除颤器植入术通常需要全身麻醉。本研究旨在确定咪达唑仑用于操作者指导下的可控镇静以及纳布啡用于镇痛的策略是否能有效减轻皮下植入式心律转复除颤器植入过程中的疼痛。
这项前瞻性研究纳入了连续接受咪达唑仑可控镇静和纳布啡联合镇痛下皮下植入式心律转复除颤器植入术的患者。使用行为疼痛量表重症监护疼痛观察工具（CPOT）在皮下植入式心律转复除颤器放置期间进行疼痛评估，并使用数字评分量表（NRS）评估患者恢复后对疼痛的回忆。CPOT评分3分及以上和NRS评分4分及以上被认为与明显疼痛相关。
本研究纳入了16例患者：10名男性（62.5%）和6名女性，平均年龄54±11岁。11例患者（68.8%）皮下植入式心律转复除颤器植入的指征为一级预防。咪达唑仑和纳布啡的平均给药剂量分别为0.11±0.03和0.27±0.05mg/kg。整个手术过程中的平均CPOT为1.4±1.6。由于所有16例患者的NRS评分均低于4分，因此没有患者出现手术疼痛回忆。皮下植入式心律转复除颤器植入期间未发生与镇静相关的严重不良事件。
本研究表明，咪达唑仑用于操作者指导下的可控镇静以及纳布啡用于镇痛可有效减轻接受皮下植入式心律转复除颤器植入术患者的手术疼痛，可能是全身麻醉的一种替代方法。
