Sedation for patients undergoing procedures in the cardiac catheterization laboratory (CCL) can be managed by the primary physician with nursing staff or by a dedicated anesthesiology team. The choice of sedation and/or anesthetic techniques is dependent on institutional policies, patient and physician preference, and the type of procedure being performed. This discussion will focus on interventional procedures in the CCL and not hybrid operating room procedures that add an additional layer of complexity and more often than not will be staffed with an anesthesia team.
CCL sedation offers patient comfort (analgesia and anxiolysis) during invasive procedures requiring patients to hold still, potentially for long periods, without resorting to general anesthesia. In pediatric populations and uncooperative adults, either deep sedation or general anesthesia, provided by an anesthesiology care provider, is typically warranted. General anesthesia may also be warranted for patients who cannot lie flat due to cardiac or pulmonary pathology or joint pain. General anesthesia is also frequently used for patients requiring transesophageal echocardiography as part of their procedure.
At times, these sedation practices may result in cardiac or respiratory depression; these must be rapidly recognized and appropriately managed to avoid the risk of hypoxic brain damage, cardiac arrest, or death. Conversely, inadequate sedation/analgesia may result in undue discomfort, patient injury due to lack of cooperation, or adverse physiologic or psychological response to stress.1
In general, patients managed with moderate sedation will have a shorter recovery period prior to return to their hospital room or discharge home. There may also be a shorter room turnover time for patients managed with sedation versus general anesthesia. Patients receiving general anesthesia must be recovered in a unit staffed with nurses trained in recovery of postanesthesia patients. If this unit is distant from the interventional area, room turnover will be delayed during transport of patients and transfer of care to the recovery team. Moderate sedation administered by a nurse under the supervision of the cardiologist may decrease the resource utilization and total institutional cost for the procedure by avoiding usage of these additional resources.
DEFINITION OF SEDATION
Sedation (minimal, moderate, or deep) and general anesthesia are defined points on an otherwise continuous scale of sedation defined by anesthesiologists (Table 20-1). At the origin of this scale, the individual is fully awake and conscious; at the opposite end, he or she is unarousable, apneic, and possibly hemodynamically unstable.
Table Graphic Jump Location Table 20-1Levels of Sedation and Anesthesia and Accompanying Physiologic Parameters2 ||Download (.pdf) Table 20-1 Levels of Sedation and Anesthesia and Accompanying Physiologic Parameters2
| ||Minimal Sedation ||Moderate Sedation ||Deep Sedation ||General Anesthesia |
|Responsiveness ||Normal response to verbal stimulation ||Purposeful response to verbal or tactile stimulationa ||Purposeful response following repeated or painful stimulationa ||Unarousable even with painful stimuli |
|Airway ||Unaffected ||No intervention required ||Intervention may be ...|