Propofol for implantable cardioverter defibrillator implantation in patients with Brugada syndrome

• DOI: 10.1111/pace.13342
• Publication Date: 2018-04-07T00:20:58Z
• Authors: Hye‐Mee Kwon; Sung‐Hoon Kim; Se‐Ung Park; Jin‐Ho Rhim; Hee‐Sun Park; Wook‐Jong Kim; Gi‐Byoung Nam
• Keywords: Adult; Male; Midazolam; Conscious Sedation; Defibrillators, Implantable; 3. Good health; Fentanyl; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Humans; Hypnotics and Sedatives; Female; Propofol; Adjuvants, Anesthesia; Brugada Syndrome; Monitoring, Physiologic

AbstractAimsAvoiding propofol in patients with Brugada syndrome has been suggested because of the theoretical risk of provoking ventricular arrhythmias, although propofol may be selected for conscious sedation during electrophysiological procedures in catheterization laboratories. This study aimed to document periprocedural electrocardiographic changes and adverse events in patients with Brugada syndrome undergoing implantable cardioverter defibrillator (ICD) implantation using propofol sedation.MethodsWe reviewed the clinical data of 53 consecutive patients who underwent ICD implantation during 1998–2011. Sedation was achieved by combining propofol with either midazolam or fentanyl, and a bolus propofol dose (0.5–1 mg/kg) was administered to induce deep sedation. Periprocedural events, including arrhythmias, defibrillations, and hyperthermia episodes, were evaluated, and electrocardiogram (ECG) variables were measured. The need for emergency anesthetic support/intubation and incidence of perioperative complications or mortality were analyzed.ResultsProcedure time and cumulative propofol dose for each patient was 125.2 (42.8) min and 204.6 (212.7) mg, respectively. During deep sedation, blood pressure, heart rate, and oxygen saturation were significantly decreased (P < 0.001) such that eight (15.1%) patients required manual ventilation and one (1.9%) needed atropine injection. No significant ECG changes were observed. Only two (3.7%) patients showed newly developed ST elevation in the anterior precordial lead, whereas three (5.6%) had isolated premature ventricular contractions.ConclusionICD implantation without significant ECG changes or adverse outcomes is feasible under propofol sedation in patients with Brugada syndrome. However, because of significant hemodynamic changes and respiratory compromise, close monitoring and meticulous propofol dose titration is warranted.