Wafae Bruna Galvão de, da Silva Rose Mary Ferreira, Veloso Henrique Horta
Medical Sciences Faculty, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Ann Card Anaesth. 2019 Apr-Jun;22(2):113-121. doi: 10.4103/aca.ACA_72_18.
Direct current cardioversion is a low-risk and standard procedure to restore normal sinus rhythm in patients with tachyarrhythmias. It requires sedation to facilitate the procedure, as it is painful and distressful. The preferred anesthetic drug must be short acting, producing conscious sedation, to enable rapid recovery after the procedure. In this sense, this narrative review focuses on the critical analysis of recent randomized studies and presents about the safety and effectiveness of propofol, comparing it with other established sedatives, mainly etomidate and midazolam. The research was performed on MEDLINE database with Propofol and Cardioversion keywords. In most cases, propofol comes to be the best option, with a quick recovery time and low rates of side effects. Different studies have demonstrated no inferiority when comparing to other drugs and, when these adverse events happened, they were easily and quickly handled. Exceptions in this scenario are those patients, particularly the elderly, with baseline important structural heart disease, in which etomidate with fentanyl has been pointed to lead to better hemodynamic stability.
直流电复律是一种低风险的标准程序，用于恢复快速性心律失常患者的正常窦性心律。由于该操作会引起疼痛和不适，因此需要使用镇静剂来辅助进行。首选的麻醉药物必须作用时间短，能产生清醒镇静效果，以便术后能快速恢复。从这个意义上讲，这篇叙述性综述着重对近期随机研究进行批判性分析，并介绍丙泊酚的安全性和有效性，将其与其他已确立的镇静剂（主要是依托咪酯和咪达唑仑）进行比较。该研究在MEDLINE数据库中使用“丙泊酚”和“复律”关键词进行。在大多数情况下，丙泊酚成为最佳选择，恢复时间快且副作用发生率低。不同研究表明，与其他药物相比，丙泊酚并不逊色，而且当出现不良事件时，它们易于且能迅速得到处理。在这种情况下的例外是那些患者，特别是患有重要结构性心脏病基线的老年人，在这些患者中，依托咪酯联合芬太尼已被指出可导致更好的血流动力学稳定性。
