Dada Rachel S, McGuire Joseph A, Hayanga J W Awori, Thibault Dylan, Schwartzman David, Ellison Matthew, Hayanga Heather K
Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH.
Department of Anesthesiology, West Virginia University, Morgantown, WV.
J Cardiothorac Vasc Anesth. 2024 Mar;38(3):675-682. doi: 10.1053/j.jvca.2023.12.021. Epub 2023 Dec 16.
The authors analyzed anesthetic management trends during ventricular tachycardia (VT) ablation, hypothesizing that (1) monitored anesthesia care (MAC) is more commonly used than general anesthesia (GA); (2) MAC uses significantly increased after release of the 2019 Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias; and (3) anesthetic approach varies based on patient and hospital characteristics.
Retrospective study.
National Anesthesia Clinical Outcomes Registry data.
Patients 18 years or older who underwent elective VT ablation between 2013 and 2021.
None.
Covariates were selected a priori within multivariate models, and interrupted time-series analysis was performed. Of the 15,505 patients who underwent VT ablation between 2013 and 2021, 9,790 (63.1%) received GA. After the 2019 Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias supported avoidance of GA in idiopathic VT, no statistically significant increase in MAC was evident (immediate change in intercept post-consensus statement release adjusted odds ratio 1.41, p = 0.1629; change in slope post-consensus statement release adjusted odds ratio 1.06 per quarter, p = 0.1591). Multivariate analysis demonstrated that sex, American Society of Anesthesiologists physical status, age, and geographic location were statistically significantly associated with the anesthetic approach.
GA has remained the primary anesthetic type for VT ablation despite the 2019 Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias suggested its avoidance in idiopathic VT. Achieving widespread clinical practice change is an ongoing challenge in medicine, emphasizing the importance of developing effective implementation strategies to facilitate awareness of guideline release and subsequent adherence to and adoption of recommendations.
作者分析了室性心动过速（VT）消融术中的麻醉管理趋势，假设（1）监护麻醉（MAC）比全身麻醉（GA）更常用；（2）《2019年室性心律失常导管消融专家共识声明》发布后，MAC的使用显著增加；（3）麻醉方法因患者和医院特征而异。
回顾性研究。
国家麻醉临床结果登记数据。
2013年至2021年间接受择期VT消融术的18岁及以上患者。
无。
在多变量模型中预先选择协变量，并进行中断时间序列分析。在2013年至2021年间接受VT消融术的15505例患者中，9790例（63.1%）接受了GA。在《2019年室性心律失常导管消融专家共识声明》支持在特发性VT中避免使用GA后，MAC的使用没有明显的统计学显著增加（共识声明发布后截距的立即变化调整优势比为1.41，p = 0.1629；共识声明发布后斜率的变化调整优势比为每季度1.06，p = 0.1591）。多变量分析表明，性别、美国麻醉医师协会身体状况、年龄和地理位置与麻醉方法在统计学上显著相关。
尽管《2019年室性心律失常导管消融专家共识声明》建议在特发性VT中避免使用GA，但GA仍然是VT消融术的主要麻醉类型。在医学领域，实现广泛的临床实践改变是一项持续的挑战，这强调了制定有效实施策略以促进对指南发布的认识以及随后遵守和采用建议的重要性。
