Department of Anesthesiology, West Virginia University, Morgantown, WV.
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV.
J Cardiothorac Vasc Anesth. 2023 Dec;37(12):2461-2469. doi: 10.1053/j.jvca.2023.07.026. Epub 2023 Jul 29.
The authors evaluated the anesthetic approach for cardiovascular implantable electronic device (CIED) placement and transvenous lead removal, hypothesizing that monitored anesthesia care is used more frequently than general anesthesia.
A retrospective study.
National Anesthesia Clinical Outcomes Registry data.
Adult patients who underwent CIED (permanent cardiac pacemaker or implantable cardioverter-defibrillator [ICD]) placement or transvenous lead removal between 2010 and 2021.
None.
Covariates were selected a priori within multivariate models to assess predictors of anesthetic type. A total of 87,530 patients underwent pacemaker placement, 76,140 had ICD placement, 2,568 had pacemaker transvenous lead removal, and 4,861 had ICD transvenous lead extraction; 51.2%, 45.64%, 16.82%, and 45.64% received monitored anesthesia care, respectively. A 2%, 1% (both p < 0.0001), and 2% (p = 0.0003) increase in monitored anesthesia care occurred for each 1-year increase in age for pacemaker placement, ICD placement, and pacemaker transvenous lead removal, respectively. American Society of Anesthesiologists (ASA) physical status ≤III for pacemaker placement, ASA ≥IV for ICD placement, and ASA ≤III for pacemaker transvenous lead removal were 7% (p = 0.0013), 5% (p = 0.0144), and 27% (p = 0.0247) more likely to receive monitored anesthesia care, respectively. Patients treated in the Northeast were more likely to receive monitored anesthesia care than in the West for all groups analyzed (p < 0.0024). Male patients were 24% less likely to receive monitored anesthesia care for pacemaker transvenous lead removal (p = 0.0378). For every additional 10 pacemaker or ICD lead removals performed in a year, a 2% decrease in monitored anesthesia care was evident (p = 0.0271, p < 0.0001, respectively).
General anesthesia still has a strong presence in the anesthetic management of both CIED placement and transvenous lead removal. Anesthetic choice, however, varies with patient demographics, hospital characteristics, and geographic region.
作者评估了心血管植入式电子设备（CIED）置入和经静脉导线拔除的麻醉方法，假设监测麻醉护理的应用频率高于全身麻醉。
回顾性研究。
国家麻醉临床结局登记数据。
2010 年至 2021 年间接受 CIED（永久性心脏起搏器或植入式心脏复律除颤器 [ICD]）置入或经静脉导线拔除的成年患者。
无。
在多变量模型中，预先选择协变量以评估麻醉类型的预测因素。共 87530 例患者行起搏器置入，76140 例患者行 ICD 置入，2568 例患者行起搏器经静脉导线拔除，4861 例患者行 ICD 经静脉导线提取；分别有 51.2%、45.64%、16.82%和 45.64%的患者接受了监测麻醉护理。起搏器置入、ICD 置入和起搏器经静脉导线拔除的年龄每增加 1 岁，监测麻醉护理的比例分别增加 2%、1%（均 p<0.0001）和 2%（p=0.0003）。起搏器置入 ASA 身体状况≤III，ICD 置入 ASA≥IV，起搏器经静脉导线拔除 ASA≤III，分别有 7%（p=0.0013）、5%（p=0.0144）和 27%（p=0.0247）更有可能接受监测麻醉护理。与分析的所有组相比，东北治疗的患者更有可能接受监测麻醉护理，而不是在西部（p<0.0024）。对于起搏器经静脉导线拔除，男性患者接受监测麻醉护理的可能性低 24%（p=0.0378）。每年每增加 10 个起搏器或 ICD 导线拔除，监测麻醉护理的比例就会降低 2%（p=0.0271，p<0.0001）。
全身麻醉在 CIED 置入和经静脉导线拔除的麻醉管理中仍占有重要地位。然而，麻醉选择因患者人口统计学特征、医院特征和地理位置而异。
