Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel

Anna Kezerashvili, John Devens Fisher, Jessica DeLaney, Savi Mushiyev, Eileen Monahan, Vanessa Taylor, Soo G. Kim, Kevin J. Ferrick, Jay N. Gross, Eugen C. Palma, Andrew K. Krumerman

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Aims: Primary: to determine the safety and efficacy of intravenous sedation for cardiac procedures administered by non-anesthesia personnel. Secondary: to assess cost effectiveness of such sedation. Methods: Anesthesiologists trained non-anesthesia personnel, and established our sedation protocol, which was then used in 9,558 patients who had cardiac procedures with sedation by non-anesthesia personnel, recorded on a computerized database. Most sedation used was midazolam (MID) and morphine (MOR). Complications and problems were derived from the database and quality assurance committee records. Doses were based on desired level of sedation and procedure duration; highest dose used: MID 78 mg, MOR 84 mg. Results: Data included catheterization (n=3,819) and transesophageal echo procedures (n=260); and overall electrophysiology (n=5,479) and selected subsets. There were complications or problems in only 9 patients (0.1%), a strong safety statement. There were 3 deaths in electrophysiology related procedures, 2 deaths in catheterization related procedures, all in very sick patients and not definitely related to sedation; 4 others developed clinical instability (hives, hypotension and heart failure-all with no sequellae), 2 of which needed reversal medications. Three patients (<0.03%) proved difficult to sedate, and their procedures were completed with help from the anesthesia department; by protocol this was not a complication. A total of $5,365,691 was saved during the last decade on cardiac procedures performed with conscious sedation. Conclusion: Non-anesthesia personnel can administer intravenous sedation for cardiac procedures in cardiac settings, with safety and cost-effectiveness demonstrated over many years. Anesthesia services are still appropriate for selected cases.

Original languageEnglish (US)
Pages (from-to)43-51
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
Volume21
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Costs and Cost Analysis
Electrophysiology
Midazolam
Safety
Catheterization
Morphine
Cost-Benefit Analysis
Hospital Anesthesia Department
Databases
Conscious Sedation
Urticaria
Hypotension
Anesthesia
Heart Failure

Keywords

  • Cardiac procedures
  • Cardiology
  • Cardioversion
  • Conscious sedation
  • Intravenous sedation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel. / Kezerashvili, Anna; Fisher, John Devens; DeLaney, Jessica; Mushiyev, Savi; Monahan, Eileen; Taylor, Vanessa; Kim, Soo G.; Ferrick, Kevin J.; Gross, Jay N.; Palma, Eugen C.; Krumerman, Andrew K.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 21, No. 1, 01.2008, p. 43-51.

Research output: Contribution to journalArticle

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abstract = "Aims: Primary: to determine the safety and efficacy of intravenous sedation for cardiac procedures administered by non-anesthesia personnel. Secondary: to assess cost effectiveness of such sedation. Methods: Anesthesiologists trained non-anesthesia personnel, and established our sedation protocol, which was then used in 9,558 patients who had cardiac procedures with sedation by non-anesthesia personnel, recorded on a computerized database. Most sedation used was midazolam (MID) and morphine (MOR). Complications and problems were derived from the database and quality assurance committee records. Doses were based on desired level of sedation and procedure duration; highest dose used: MID 78 mg, MOR 84 mg. Results: Data included catheterization (n=3,819) and transesophageal echo procedures (n=260); and overall electrophysiology (n=5,479) and selected subsets. There were complications or problems in only 9 patients (0.1{\%}), a strong safety statement. There were 3 deaths in electrophysiology related procedures, 2 deaths in catheterization related procedures, all in very sick patients and not definitely related to sedation; 4 others developed clinical instability (hives, hypotension and heart failure-all with no sequellae), 2 of which needed reversal medications. Three patients (<0.03{\%}) proved difficult to sedate, and their procedures were completed with help from the anesthesia department; by protocol this was not a complication. A total of $5,365,691 was saved during the last decade on cardiac procedures performed with conscious sedation. Conclusion: Non-anesthesia personnel can administer intravenous sedation for cardiac procedures in cardiac settings, with safety and cost-effectiveness demonstrated over many years. Anesthesia services are still appropriate for selected cases.",
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