Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysis
Abstract There is a rising number in complications associated with more cardiac electrical devices implanted (CIED). Infection and lead dysfunction are reasons to perform transvenous lead extraction. An ideal anaesthetic approach has not been described yet. Most centres use general anaesthesia, but...
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Nature Portfolio
2023-12-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-50372-1 |
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| author | Fabian Schiedat Julian Fischer Assem Aweimer Dominik Schöne Ibrahim El-Battrawy Christoph Hanefeld Andreas Mügge Axel Kloppe |
| author_facet | Fabian Schiedat Julian Fischer Assem Aweimer Dominik Schöne Ibrahim El-Battrawy Christoph Hanefeld Andreas Mügge Axel Kloppe |
| author_sort | Fabian Schiedat |
| collection | DOAJ |
| description | Abstract There is a rising number in complications associated with more cardiac electrical devices implanted (CIED). Infection and lead dysfunction are reasons to perform transvenous lead extraction. An ideal anaesthetic approach has not been described yet. Most centres use general anaesthesia, but there is a lack in studies looking into deep sedation (DS) as an anaesthetic approach. We report our retrospective experience for a large number of procedures performed with deep sedation as a primary approach. Extraction procedures performed between 2011 and 2018 in our electrophysiology laboratory have been included retrospectively. We began by applying a bolus injection of piritramide followed by midazolam as primary medication and would add etomidate if necessary. For extraction of leads a stepwise approach with careful traction, locking stylets, dilator sheaths, mechanical rotating sheaths and if needed snares and baskets has been used. A total of 780 leads in 463 patients (age 69.9 ± 12.3, 31.3% female) were extracted. Deep sedation was successful in 97.8% of patients. Piritramide was used as the main analgesic medication (98.5%) and midazolam as the main sedative (94.2%). Additional etomidate was administered in 15.1% of cases. In 2.2% of patients a conversion to general anaesthesia was required as adequate level of DS was not achieved before starting the procedure. Sedation related complications occurred in 1.1% (n = 5) of patients without sequalae. Deep sedation with piritramide, midazolam and if needed additional etomidate is a safe and feasible strategy for transvenous lead extraction. |
| first_indexed | 2024-03-08T18:15:55Z |
| format | Article |
| id | doaj.art-bb3d72d6b2d142bf9ffdddd00cc37caf |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-08T18:15:55Z |
| publishDate | 2023-12-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-bb3d72d6b2d142bf9ffdddd00cc37caf2023-12-31T12:11:12ZengNature PortfolioScientific Reports2045-23222023-12-011311710.1038/s41598-023-50372-1Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysisFabian Schiedat0Julian Fischer1Assem Aweimer2Dominik Schöne3Ibrahim El-Battrawy4Christoph Hanefeld5Andreas Mügge6Axel Kloppe7Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-UniversityDepartment of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University BochumDepartment of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-UniversityDepartment of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University BochumDepartment of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-UniversityDepartment of Cardiology at Katholische Kliniken Bochum of the Ruhr UniversityDepartment of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-UniversityDepartment of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University BochumAbstract There is a rising number in complications associated with more cardiac electrical devices implanted (CIED). Infection and lead dysfunction are reasons to perform transvenous lead extraction. An ideal anaesthetic approach has not been described yet. Most centres use general anaesthesia, but there is a lack in studies looking into deep sedation (DS) as an anaesthetic approach. We report our retrospective experience for a large number of procedures performed with deep sedation as a primary approach. Extraction procedures performed between 2011 and 2018 in our electrophysiology laboratory have been included retrospectively. We began by applying a bolus injection of piritramide followed by midazolam as primary medication and would add etomidate if necessary. For extraction of leads a stepwise approach with careful traction, locking stylets, dilator sheaths, mechanical rotating sheaths and if needed snares and baskets has been used. A total of 780 leads in 463 patients (age 69.9 ± 12.3, 31.3% female) were extracted. Deep sedation was successful in 97.8% of patients. Piritramide was used as the main analgesic medication (98.5%) and midazolam as the main sedative (94.2%). Additional etomidate was administered in 15.1% of cases. In 2.2% of patients a conversion to general anaesthesia was required as adequate level of DS was not achieved before starting the procedure. Sedation related complications occurred in 1.1% (n = 5) of patients without sequalae. Deep sedation with piritramide, midazolam and if needed additional etomidate is a safe and feasible strategy for transvenous lead extraction.https://doi.org/10.1038/s41598-023-50372-1 |
| spellingShingle | Fabian Schiedat Julian Fischer Assem Aweimer Dominik Schöne Ibrahim El-Battrawy Christoph Hanefeld Andreas Mügge Axel Kloppe Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysis Scientific Reports |
| title | Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysis |
| title_full | Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysis |
| title_fullStr | Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysis |
| title_full_unstemmed | Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysis |
| title_short | Success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction: a retrospective analysis |
| title_sort | success and safety of deep sedation as a primary anaesthetic approach for transvenous lead extraction a retrospective analysis |
| url | https://doi.org/10.1038/s41598-023-50372-1 |
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