Kwon Hye-Mee, Kim Sung-Hoon, Park Se-Ung, Rhim Jin-Ho, Park Hee-Sun, Kim Wook-Jong, Nam Gi-Byoung
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Internal Medicine (Cardiology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Pacing Clin Electrophysiol. 2018 Jun;41(6):656-660. doi: 10.1111/pace.13342. Epub 2018 May 4.
Avoiding propofol in patients with Brugada syndrome has been suggested because of the theoretical risk of provoking ventricular arrhythmias, although propofol may be selected for conscious sedation during electrophysiological procedures in catheterization laboratories. This study aimed to document periprocedural electrocardiographic changes and adverse events in patients with Brugada syndrome undergoing implantable cardioverter defibrillator (ICD) implantation using propofol sedation.
We reviewed the clinical data of 53 consecutive patients who underwent ICD implantation during 1998-2011. Sedation was achieved by combining propofol with either midazolam or fentanyl, and a bolus propofol dose (0.5-1 mg/kg) was administered to induce deep sedation. Periprocedural events, including arrhythmias, defibrillations, and hyperthermia episodes, were evaluated, and electrocardiogram (ECG) variables were measured. The need for emergency anesthetic support/intubation and incidence of perioperative complications or mortality were analyzed.
Procedure time and cumulative propofol dose for each patient was 125.2 (42.8) min and 204.6 (212.7) mg, respectively. During deep sedation, blood pressure, heart rate, and oxygen saturation were significantly decreased (P < 0.001) such that eight (15.1%) patients required manual ventilation and one (1.9%) needed atropine injection. No significant ECG changes were observed. Only two (3.7%) patients showed newly developed ST elevation in the anterior precordial lead, whereas three (5.6%) had isolated premature ventricular contractions.
ICD implantation without significant ECG changes or adverse outcomes is feasible under propofol sedation in patients with Brugada syndrome. However, because of significant hemodynamic changes and respiratory compromise, close monitoring and meticulous propofol dose titration is warranted.
由于理论上存在诱发室性心律失常的风险，有人建议布加综合征患者避免使用丙泊酚，尽管在导管室进行电生理检查时可选择丙泊酚进行清醒镇静。本研究旨在记录使用丙泊酚镇静进行植入式心律转复除颤器（ICD）植入的布加综合征患者围手术期的心电图变化和不良事件。
我们回顾了1998年至2011年间连续53例接受ICD植入的患者的临床资料。通过将丙泊酚与咪达唑仑或芬太尼联合使用来实现镇静，并给予单次丙泊酚剂量（0.5 - 1mg/kg）以诱导深度镇静。评估围手术期事件，包括心律失常、除颤和体温过高发作，并测量心电图（ECG）变量。分析对紧急麻醉支持/插管的需求以及围手术期并发症或死亡率。
每位患者的手术时间和丙泊酚累积剂量分别为125.2（42.8）分钟和204.6（212.7）毫克。在深度镇静期间，血压、心率和血氧饱和度显著降低（P < 0.001），以至于8例（15.1%）患者需要手动通气，1例（1.9%）需要注射阿托品。未观察到明显的心电图变化。只有2例（3.7%）患者在前胸导联出现新的ST段抬高，而3例（5.6%）有孤立的室性早搏。
在布加综合征患者中，丙泊酚镇静下进行ICD植入且无明显心电图变化或不良后果是可行的。然而，由于显著的血流动力学变化和呼吸功能受损，需要密切监测并仔细滴定丙泊酚剂量。
