A retrospective analysis of proceduralist-directed, nurse-administered propofol sedation for implantable cardioverter-defibrillator procedures

Sameh Sayfo, Kairav P. Vakil, Ahmad Alqaqa'A, Helen Flippin, Deepak Bhakta, Anil V. Yadav, John M. Miller, William J. Groh

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: There is controversy whether proceduralist-directed, nurse-administered propofol sedation (PDNAPS) is safe. Objective: To assess the frequency of adverse events when PDNAPS is used for implantable cardioverter-defibrillator (ICD)-related procedures and to determine the patient and procedural characteristics associated with adverse events. Methods: Consecutive ICD-related procedures using PDNAPS from May 2006 to July 2009 at a tertiary-care hospital were evaluated. Serious adverse events were defined as procedural death, unexpected transfer to an intensive care unit, respiratory failure requiring intubation/bag-mask ventilation, or hypotension requiring vasoconstrictor/inotrope support. Nonserious adverse events were defined as hypotension requiring fluid resuscitation or hypoxemia requiring augmented respiratory support with non-rebreather mask, oral airway, or jaw lift. Results: Of 582 patients (age 64 ± 14 years, 72.3% males) undergoing ICD-related procedures using PDNAPS, 58 (10.0%) patients had serious adverse events with no procedural death and 225 (38.7%) had nonserious adverse events. Longer procedure duration (relative risk [RR] = 2.1 per hour; 95% confidence interval [CI] = 1.6-2.8; P <.001) and biventricular implant (RR = 2.7; CI = 1.4-5.3; P =.003) were independent predictors of serious adverse events. A longer procedure duration (RR = 1.4 per hour; CI = 1.1-1.7; P =.001), heart failure class (RR = 1.4 per 1 class; CI = 1.1-1.7; P =.002), and use of propofol infusion (RR = 3.5; CI = 2.2-5.7; P <.001) were independent predictors of nonserious adverse events. Conclusion: PDNAPS for shorter ICD procedures including single- and dual-chamber implants, generator changes, and defibrillation threshold testing have acceptable rates of serious adverse events and manageable nonserious adverse events and should be considered for further study. Biventricular implants and other complex procedures should be done with an anesthesiologist.

Original languageEnglish (US)
Pages (from-to)342-346
Number of pages5
JournalHeart Rhythm
Volume9
Issue number3
DOIs
StatePublished - Mar 1 2012

Fingerprint

Implantable Defibrillators
Propofol
Nurses
Confidence Intervals
Masks
Hypotension
Vasoconstrictor Agents
Tertiary Healthcare
Jaw
Intubation
Tertiary Care Centers
Resuscitation
Respiratory Insufficiency
Intensive Care Units
Heart Failure

Keywords

  • Adverse events
  • Defibrillator implantation
  • Outcome
  • Propofol
  • Sedation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

A retrospective analysis of proceduralist-directed, nurse-administered propofol sedation for implantable cardioverter-defibrillator procedures. / Sayfo, Sameh; Vakil, Kairav P.; Alqaqa'A, Ahmad; Flippin, Helen; Bhakta, Deepak; Yadav, Anil V.; Miller, John M.; Groh, William J.

In: Heart Rhythm, Vol. 9, No. 3, 01.03.2012, p. 342-346.

Research output: Contribution to journalArticle

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abstract = "Background: There is controversy whether proceduralist-directed, nurse-administered propofol sedation (PDNAPS) is safe. Objective: To assess the frequency of adverse events when PDNAPS is used for implantable cardioverter-defibrillator (ICD)-related procedures and to determine the patient and procedural characteristics associated with adverse events. Methods: Consecutive ICD-related procedures using PDNAPS from May 2006 to July 2009 at a tertiary-care hospital were evaluated. Serious adverse events were defined as procedural death, unexpected transfer to an intensive care unit, respiratory failure requiring intubation/bag-mask ventilation, or hypotension requiring vasoconstrictor/inotrope support. Nonserious adverse events were defined as hypotension requiring fluid resuscitation or hypoxemia requiring augmented respiratory support with non-rebreather mask, oral airway, or jaw lift. Results: Of 582 patients (age 64 ± 14 years, 72.3{\%} males) undergoing ICD-related procedures using PDNAPS, 58 (10.0{\%}) patients had serious adverse events with no procedural death and 225 (38.7{\%}) had nonserious adverse events. Longer procedure duration (relative risk [RR] = 2.1 per hour; 95{\%} confidence interval [CI] = 1.6-2.8; P <.001) and biventricular implant (RR = 2.7; CI = 1.4-5.3; P =.003) were independent predictors of serious adverse events. A longer procedure duration (RR = 1.4 per hour; CI = 1.1-1.7; P =.001), heart failure class (RR = 1.4 per 1 class; CI = 1.1-1.7; P =.002), and use of propofol infusion (RR = 3.5; CI = 2.2-5.7; P <.001) were independent predictors of nonserious adverse events. Conclusion: PDNAPS for shorter ICD procedures including single- and dual-chamber implants, generator changes, and defibrillation threshold testing have acceptable rates of serious adverse events and manageable nonserious adverse events and should be considered for further study. Biventricular implants and other complex procedures should be done with an anesthesiologist.",
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AU - Flippin, Helen

AU - Bhakta, Deepak

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AU - Miller, John

AU - Groh, William

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N2 - Background: There is controversy whether proceduralist-directed, nurse-administered propofol sedation (PDNAPS) is safe. Objective: To assess the frequency of adverse events when PDNAPS is used for implantable cardioverter-defibrillator (ICD)-related procedures and to determine the patient and procedural characteristics associated with adverse events. Methods: Consecutive ICD-related procedures using PDNAPS from May 2006 to July 2009 at a tertiary-care hospital were evaluated. Serious adverse events were defined as procedural death, unexpected transfer to an intensive care unit, respiratory failure requiring intubation/bag-mask ventilation, or hypotension requiring vasoconstrictor/inotrope support. Nonserious adverse events were defined as hypotension requiring fluid resuscitation or hypoxemia requiring augmented respiratory support with non-rebreather mask, oral airway, or jaw lift. Results: Of 582 patients (age 64 ± 14 years, 72.3% males) undergoing ICD-related procedures using PDNAPS, 58 (10.0%) patients had serious adverse events with no procedural death and 225 (38.7%) had nonserious adverse events. Longer procedure duration (relative risk [RR] = 2.1 per hour; 95% confidence interval [CI] = 1.6-2.8; P <.001) and biventricular implant (RR = 2.7; CI = 1.4-5.3; P =.003) were independent predictors of serious adverse events. A longer procedure duration (RR = 1.4 per hour; CI = 1.1-1.7; P =.001), heart failure class (RR = 1.4 per 1 class; CI = 1.1-1.7; P =.002), and use of propofol infusion (RR = 3.5; CI = 2.2-5.7; P <.001) were independent predictors of nonserious adverse events. Conclusion: PDNAPS for shorter ICD procedures including single- and dual-chamber implants, generator changes, and defibrillation threshold testing have acceptable rates of serious adverse events and manageable nonserious adverse events and should be considered for further study. Biventricular implants and other complex procedures should be done with an anesthesiologist.

AB - Background: There is controversy whether proceduralist-directed, nurse-administered propofol sedation (PDNAPS) is safe. Objective: To assess the frequency of adverse events when PDNAPS is used for implantable cardioverter-defibrillator (ICD)-related procedures and to determine the patient and procedural characteristics associated with adverse events. Methods: Consecutive ICD-related procedures using PDNAPS from May 2006 to July 2009 at a tertiary-care hospital were evaluated. Serious adverse events were defined as procedural death, unexpected transfer to an intensive care unit, respiratory failure requiring intubation/bag-mask ventilation, or hypotension requiring vasoconstrictor/inotrope support. Nonserious adverse events were defined as hypotension requiring fluid resuscitation or hypoxemia requiring augmented respiratory support with non-rebreather mask, oral airway, or jaw lift. Results: Of 582 patients (age 64 ± 14 years, 72.3% males) undergoing ICD-related procedures using PDNAPS, 58 (10.0%) patients had serious adverse events with no procedural death and 225 (38.7%) had nonserious adverse events. Longer procedure duration (relative risk [RR] = 2.1 per hour; 95% confidence interval [CI] = 1.6-2.8; P <.001) and biventricular implant (RR = 2.7; CI = 1.4-5.3; P =.003) were independent predictors of serious adverse events. A longer procedure duration (RR = 1.4 per hour; CI = 1.1-1.7; P =.001), heart failure class (RR = 1.4 per 1 class; CI = 1.1-1.7; P =.002), and use of propofol infusion (RR = 3.5; CI = 2.2-5.7; P <.001) were independent predictors of nonserious adverse events. Conclusion: PDNAPS for shorter ICD procedures including single- and dual-chamber implants, generator changes, and defibrillation threshold testing have acceptable rates of serious adverse events and manageable nonserious adverse events and should be considered for further study. Biventricular implants and other complex procedures should be done with an anesthesiologist.

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