General anesthesia may not be necessary during cryoablation procedures for atrial fibrillation, a small study suggested.
Conscious sedation with dexmedetomidine (Precedex) plus some fentanyl and midazolam (Versed) was enough to keep patients comfortable through the procedure without any recollection afterward of the painful phrenic nerve pacing involved, Patricia Gasper, RN, electrophysiology coordinator at Memorial Leighton Heart and Vascular Center in South Bend, Ind., and colleagues found.
The strategy also saved $1,816 per patient on medication alone compared with general anesthesia, the group reported here at the Heart Rhythm Society meeting.
“It’s very safe — during our study of 88 patients, we didn’t have to convert anyone over to general anesthesia from moderate sedation,” Gasper added in an interview with MedPage Today.
Moderate sedation has been standard with radiofrequency ablation, but general anesthesia has become the standard with cryoablation.
“It wasn’t thought we could get the patient comfortable enough with moderate sedation,” Gasper explained.
Because of the possibility of right phrenic nerve palsy as a complication, “you need to pace the phrenic nerve the whole time, which can be very uncomfortable, it’s like chronic hiccuping for the patient.”
Since general anesthesia carries some risks of morbidity and mortality itself, her center switched to conscious sedation kept at a level of 5 on the Ramsay scale.
The strategy included dexmedetomidine with a mean starting dose of 0.50 μg/kg per hour, titrated up to a maximum dose of 0.65 μg/kg per hour at the nurse’s discretion under supervision of the attending physician. No loading was done so as to avoid hypotension.