Which sedative is best for cardioversion in the emergency department?
Sedation for cardioversion in the emergency department: analysis of effectiveness in four protocols Four sedative regimens (propofol, etomidate, midazolam, and midazolam/flumazenil) were uniformly effective in facilitating ED cardioversion in hemodynamically stable adults.
What medications are used for pharmacological cardioversion?
The medications or classes of medications used for pharmacological cardioversion are specific to the condition being treated: Adenosine Used for supraventricular tachycardia (SVT) that is not atrial fibrillation, adenosine is the newest of the pharmacological cardioversion agents.
What is electrical cardioversion used to treat?
This is called electrical cardioversion. Arrhythmias may prevent blood from circulating properly to your heart and brain. Most often, doctors use cardioversion to treat a fast, irregular heart rhythm called atrial fibrillation. If you have electrical cardioversion, you’ll get medicine to put you to sleep so you don’t feel the shock.
What is the best way to manage side effects after cardioversion?
As noted above, the best management for after electrical cardioversion is to provide the patient with sedation. Pain medication may also be administered if the patient's pain is significant. Side effects of pharmacological cardioversion are specific to the medication used.
How do you sedate before cardioversion?
Propofol, methohexital, thiopentone and etomidate all appear to be good choices for procedural sedation in patients requiring electrical cardioversion for atrial fibrillation, atrial flutter and paroxysmal supraventricular tachycardia.
Do you need IV sedation for cardioversion?
Brief general anesthesia is required for elective cardioversion in hemodynamically stable patients. The pharmacological agent used to facilitate cardioversion should rapidly achieve the desired depth of anesthesia, should wear off rapidly, and should not cause cardiovascular or respiratory side effects.
Are clients sedated for cardioversion?
External cardioversion is a short, painful procedure with a stimulus intensity similar to that of a surgical incision. The level of sedation required for cardioversion is either “deep sedation” or general anaesthesia.
Is moderate sedation included in cardioversion?
Previously, the moderate sedation codes were not allowed to be billed along with the cardioversion codes. However, in 2017, this restriction was removed, and they now can be billed together.
Are you unconscious for cardioversion?
You will probably be unconscious from the anesthesia for less than 5 minutes and will not remember the shock. You will not feel any pain during the procedure.
Are you asleep during cardioversion?
Because the shock would be painful for a patient who is awake, an intravenous medication is given to sedate the patient. Patients are asleep during the cardioversion and most do not remember the procedure. It is not usually necessary to have a breathing tube (endotracheal tube) placed before the procedure.
How long does cardioversion procedure take?
Cardioversion itself takes about 5 minutes. But the whole procedure, including recovery, will probably take 30 to 45 minutes. You may take an anticoagulant medicine before and after cardioversion.
How much propofol is needed for cardioversion?
1. Propofol at a dose of 1 mg/kg for hemodynamically stable patients and 0.5mg/kg in hemodynamically unstable patients appears to be a safe drug for procedural sedation in DC cardioversion of atrial tachyarrhythmias. 2.
Why is sedation used after cardioversion?
In the event the patient is not stable enough to wait for sedation before cardioversion, sedation is often used after the fact to help the patient manage discomfort post-shock. Patients often report a retrograde amnesia effect from the use of sedation after cardioversion and cannot remember the actual procedure.
Why is cardioversion used for pharmacological solutions?
Use of the term cardioversion for pharmacological solutions is less common, probably because there is a variety of uses for medications that might cause an immediate change in the heart rhythm —traditionally known as cardioversion—but can also be used chronically to control heart rate or rhythm .
What is the conversion of a cardiac (heart) arrhythmia into an alternative cardiac rhythm?
Cardioversion is the conversion of a cardiac (heart) arrhythmia into an alternative cardiac rhythm. Cardioversion refers to a variety of medical procedures. The most common involve either medications (pharmacological cardioversion ) or electricity (electrical cardioversion or defibrillation). 1 Which method is used depends on the patient's condition and overall stability.
How does electrical cardioversion work?
Process. Electrical cardioversion uses electrodes that are several inches across to conduct electricity through the heart muscle. The electrodes can be placed externally on the chest wall or internally directly on the heart muscle. There are different types of electrical cardioversion, but they all use the same device known as a defibrillator.
What are the two most common types of cardioversion?
The types of cardioversion that might be performed by either a medical professional or a lay rescuer depend mainly on the medical condition experienced by the patient and on the severity of the patient's condition. Electrical and pharmacological are the two most common types of cardioversion.
What is the same as a defibrillator?
There are different types of electrical cardioversion, but they all use the same device known as a defibrillator. Defibrillators come in manual and automated versions. Some of them are capable of being used in either mode. Defibrillators are used when a patient is in certain cardiac rhythms such as ventricular fibrillation or unstable ventricular ...
What are the side effects of electrical cardioversion?
Some side effects of electrical cardioversion include pain and irritation at the site of the electrodes, soreness in the chest, and anxiety. As noted above, the best management for after electrical cardioversion is to provide the patient with sedation. Pain medication may also be administered if the patient's pain is significant.
How is cardioversion done?
Cardioversion is usually done by sending electric shocks to your heart through electrodes placed on your chest. It's also possible to do cardioversion with medications. Cardioversion is usually a scheduled procedure that's performed in a hospital. You should be able to go home the same day as your procedure.
What is cardioversion in medical terms?
Cardioversion is a medical procedure that restores a normal heart rhythm in people with certain types of abnormal heartbeats (arrhythmias). Cardioversion is usually done by sending electric shocks to your heart ...
What is the name of the machine that records your heart rhythm?
A nurse or technician places several large patches called electrodes on your chest. The electrodes connect to a cardioversion machine (defibrillator) using wires. The machine records your heart rhythm and delivers shocks to your heart to restore a normal heart rhythm. This machine can also correct your heart's rhythm if it beats too slowly after cardioversion.
How long before cardioversion can you eat?
However, if your symptoms are severe, you may need to have cardioversion in an emergency setting. You typically can't eat or drink anything for about eight hours before your procedure.
What to do before cardioversion?
If necessary, your doctor may prescribe blood-thinning medications before the procedure or will check for blood clots in your heart before cardioversion.
How long does it take to do electric cardioversion?
Once you're sedated, electric cardioversion usually takes only a few minutes to complete.
Why do we do cardioversion?
Cardioversion is usually done to treat people who have atrial fibrillation or atrial flutter. These conditions occur when the electrical signals that normally make your heart beat at a regular rate don't travel properly through ...
What is cardioversion used for?
Cardioversion also treats other kinds of abnormal heartbeats, including atrial flutter, atrial tachycardia and ventricular tachycardia. Cardioversion or defibrillation is also used in emergency situations for people who suffer sudden life threatening arrhythmias.
Why do people have cardioversion?
People have non-emergency or elective cardioversion to treat arrhythmias. The electrical signals that control your heartbeat start in the upper right chamber of your heart (atrium). In atrial fibrillation, very fast, irregular electrical signals move through both of the upper chambers of your heart. This can make your heartbeat fast and irregular. Some people who have atrial fibrillation don’t notice any changes in the way they feel. But others feel:
What are the risks of cardioversion?
If you have atrial fibrillation, blood clots can form in your heart’s left atrium. Cardioversion may knock loose a blood clot in your left atrium. If the clot (embolus) travels to your brain, it can cause a stroke. To avoid this, your doctor may give you medicine (such as warfarin) to make your blood less likely to form blood clots. If your doctor gives you the medicine, you’ll need to take it for 2 to 3 weeks before the procedure. Transesophageal echocardiography (TEE) is often used to check for the presence of blood clots before this procedure.
How does an IV shock work?
You won’t feel pain during the procedure. Your doctor will deliver an electrical shock through two paddles. One is placed on your chest and the other on your back.
What is cardioversion in anaesthesia?
The gold standard for cardioversion is a brief period of general anaesthesia or deep sedation using short acting agents with a rapid recovery profile. It requires the presence of an airway specialist (that is, an anaesthetist) to provide controlled airway support and maintenance of the cardiac output if required. A significant cost reduction and a shorter waiting time has been demonstrated by using nurse led sedation, but it is likely that the patients are being exposed to unnecessary risks. The patient population for cardioversion are not straightforward to deeply sedate or anaesthetise, as they have co-existent medical problems and may have a reduced cardiac output after the procedure. 17 The study by Boodhoo and colleagues 3 is underpowered to demonstrate safety of a nurse led strategy. Patient selection is crucial and obese patients and patients whose status is ASA III should certainly be managed by airway specialists. The use of capnography could improve early identification of respiratory depression and a combination of this, adequate patient selection, and very close cover should be considered by any department thinking about setting up such a system. Careful auditing of any new approach is essential and it has been suggested that a national confidential enquiry into sedation induced adverse events may be the only way to truly assess the safety of non-anaesthetist deep sedation. 18
What is external cardioversion?
External cardioversion is a short, painful procedure with a stimulus intensity similar to that of a surgical incision. The level of sedation required for cardioversion is either “deep sedation” or general anaesthesia. Adequate depths of sedation are important to firstly prevent recall of an unpleasant experience and secondly to attenuate the catecholamine surge of the stress response. This is particularly important in a patient population with a high rate of myocardial ischaemia and when rhythm stabilisation is the ultimate goal. The levels of sedation described by Boodhoo and colleagues 3 would be classified as moderate to deep sedation (that is, responding to tactile or painful stimulus). They report no significant respiratory events, or need for reversal of over-sedation with flumazanil, but report a recall rate of 1 in 50. This superficially appears to be a good result; however, general anaesthesia has a reported awareness with recall rate of less than 0.3% and an excellent safety record with mortality rates less than 1 in 185 000. 4 Their study of 394 procedures is underpowered to make any claims of safety.
What are the lessons learned from physician led sedation?
Many of the lessons learnt in physician led sedation have come from the gastroenterologists. In their guidelines for sedation they suggest the assistance of an anaesthetist if the patient has the potential for deep sedation together with one or more sedation related risk factors. 6 The latter includes patients with predicted difficult airways and significant medical conditions. Many patients with atrial fibrillation will classify as American Society of Anesthesiologists (ASA) III; that is a patient with severe systemic disease that is not incapacitating. It is known that ASA III patients tolerate adverse events poorly and have a higher surgical mortality. 7 Of particular concern is that a cardiorespiratory event secondary to over-sedation may be poorly tolerated in these patients. Furthermore, a cardiac event secondary to a primary airway problem that is not recognised could wrongly be attributed to the patient’s poor baseline cardiac status. This could lead to a falsely low reporting of sedation related events.
