Chapter 32: Anesthesia and Sedation for Cardiac Electrophysiology Procedures

First of all, the proper monitoring must be determined with a specific individual dedicated to monitoring the patient during sedation and analgesia. When moderate sedation is planned, an individual with advanced cardiac life support skills (plus certified and experienced in sedation) must be immediately available. All significantly invasive electrophysiology procedures (e.g., nonsubcutaneous implants, electrophysiology studies and ablation procedures, and high voltage shock delivery procedures) must include monitoring of blood pressure (BP), end-tidal CO2 (ETCO2), oxygen saturation (SaO2), and a multichannel ECG.

Additionally, temperature monitoring may be required for some procedures. Certain procedures may need additional indwelling catheters to measure central venous pressure (CVP), continuous arterial pressure, and pulmonary artery pressure. These intravascular lines also permit arterial blood gas sampling. Additional monitoring also may be required to assess the level of anticoagulation with heparin using an activated clotting time machine and the effect of a reversal agent such as protamine. This equipment may be remembered using the mnemonic “SOAP”: S is for suction, O is for oxygen cannula, A is for airway, and P is for pharmacology (i.e., medications used to sedate).

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