Anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: Perspectives from the clinical experience of a US panel of physicians

作者：Essandoh Michael K; Mark George E; Aa**o Johan D; Joyner Charles A; Sharma Saumya; Decena Beningo F; Bolin Eric D; Weiss Raul; Burke Martin C; McClernon Timothy R; Daoud Emile G; Gold Michael R^*

来源：Pacing and Clinical Electrophysiology, 2018, 41(7): 807-816.

DOI：10.1111/pace.13364

• defibrillation testing
• general anesthesia
• monitored anesthesia care
• regional anesthesia
• nonanesthesiologist administered sedation and analgesia
• subcutaneous implantable cardioverter-defibrillator
• transvenous implantable cardioverter-defibrillator

Background and objectiveWorldwide adoption of the subcutaneous implantable cardioverter-defibrillator (S-ICD) for preventing sudden cardiac death continues to increase, as longer-term evidence demonstrating the safety and efficacy of the S-ICD expands. As a relatively new technology, comprehensive anesthesia guidance for the management of patients undergoing S-ICD placement is lacking. This article presents advantages and disadvantages of different periprocedural sedation and anesthesia options for S-ICD implants including general anesthesia, monitored anesthesia care, regional anesthesia, and nonanesthesia personnel administered sedation and analgesia.
MethodsGuidance, for approaches to anesthesia care during S-ICD implantation, is presented based upon literature review and consensus of a panel of high-volume S-ICD implanters, a regional anesthesiologist, and a cardiothoracic anesthesiologist with significant S-ICD experience. The panel developed suggested actions for perioperative sedation, anesthesia, surgical practices, and a decision algorithm for S-ICD implantation.
ConclusionsWhile S-ICD implantation currently requires higher sedation than transvenous ICD systems, the panel consensus is that general anesthesia is not required or is obligatory for the majority of patients for the experienced S-ICD implanter. The focus of the implanting physician and the anesthesia services should be to maximize patient comfort and take into consideration patient-specific comorbidities, with a low threshold to consult the anesthesiology team.

• 出版日期2018-7