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Anesthetic considerations for electrophysiology, interventional cardiology, and transesophageal echocardiography procedures

Authors
Wendy L Gross, MD
Douglas C Shook, MD, FASE
Kathleen Evangelista, MS, CRNA
Section Editors
Jonathan B Mark, MD
Bradley P Knight, MD, FACC
Deputy Editor
Nancy A Nussmeier, MD, FAHA

INTRODUCTION

Due to advances in technology in electrophysiology (EP), interventional cardiology, and transesophageal echocardiography (TEE) technology, complex interventional procedures that may require anesthesia care are usually performed in these specialized settings remote from the main operating rooms. Many patients requiring such procedures have severe cardiovascular disease or pulmonary comorbidity; thus, they are at high risk for oversedation and hemodynamic instability. Even relatively healthy patients may not tolerate remaining motionless during prolonged or painful interventional procedures. For these reasons, the number of cases that require monitored anesthesia care (MAC) or general anesthesia in these off-site settings has increased (eg, >50 percent of EP cases [1]). Given the special considerations and growing need, some institutions have a subspecialized anesthesia team dedicated to these settings.

This topic will review anesthetic management of adult patients undergoing procedures in EP, interventional cardiology, and TEE suites. Anesthetic considerations in other off-site settings (eg, magnetic resonance imaging [MRI], computed tomography [CT], gastrointestinal endoscopy) are reviewed in other topics. (See "Anesthesia for magnetic resonance imaging and computed tomography procedures" and "Anesthesia for gastrointestinal endoscopy in adults".)  

PREANESTHESIA PLANNING

Multiple factors affect the selection of anesthetic technique, dosing of anesthetic and adjuvant agents, and whether invasive monitoring will be employed for electrophysiology (EP), interventional cardiology, or transesophageal echocardiography (TEE) procedures. Unique patient- or procedure-related considerations are discussed in advance with members of the interventional team [2]. (See "Operating room hazards and approaches to improve patient safety", section on 'Briefings'.)

Anesthetic challenges in off-site locations — Typically, EP, interventional cardiology, and TEE suites are remote from the main operating room (OR) area. Challenges for anesthesiologists in such off-site locations often include lack of standard anesthesia machines, monitors, supplies, or scavenging equipment for anesthetic gases. Additional time is required for transport of necessary items from a distant OR location, and subsequent setup and positioning of all equipment in the off-site location. Ensuring availability of well-located portable shields, lead aprons, thyroid collars, and eye protection for all anesthesia personnel is necessary for procedures with radiation risks. Another challenge is interdisciplinary communication, which may be hindered by lack of familiarity with the procedures and techniques planned by each specialist. Further discussion of challenges in remote locations is available elsewhere. (See "Anesthesia for magnetic resonance imaging and computed tomography procedures", section on 'Anesthetic challenges in remote locations' and "Anesthesia for magnetic resonance imaging and computed tomography procedures", section on 'Radiation risks'.)

Patient and procedure-related considerations — The following factors should be considered:

                                  

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Literature review current through: Mar 2017. | This topic last updated: Mar 21, 2017.
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Top
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Topic Outline

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