Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel.
OBJECTIVE
Primary: to determine the safety and efficacy of intravenous sedation for cardiac procedures administered by non-anesthesia personnel. Secondary: to assess cost effectiveness of such sedation.


METHODS
Anesthesiologists trained non-anesthesia personnel, and established our sedation protocol, which was then used in 9,558 patients who had cardiac procedures with sedation by non-anesthesia personnel, recorded on a computerized database. Most sedation used was midazolam (MID) and morphine (MOR). Complications and problems were derived from the database and quality assurance committee records. Doses were based on desired level of sedation and procedure duration; highest dose used: MID 78 mg, MOR 84 mg.


RESULTS
Data included catheterization (n = 3,819) and transesophageal echo procedures (n = 260); and overall electrophysiology (n = 5,479) and selected subsets. There were complications or problems in only 9 patients (0.1%), a strong safety statement. There were 3 deaths in electrophysiology related procedures, 2 deaths in catheterization related procedures, all in very sick patients and not definitely related to sedation; 4 others developed clinical instability (hives, hypotension and heart failure-all with no sequellae), 2 of which needed reversal medications. Three patients (<0.03%) proved difficult to sedate, and their procedures were completed with help from the anesthesia department; by protocol this was not a complication. A total of $5,365,691 was saved during the last decade on cardiac procedures performed with conscious sedation.


CONCLUSIONS
Non-anesthesia personnel can administer intravenous sedation for cardiac procedures in cardiac settings, with safety and cost-effectiveness demonstrated over many years. Anesthesia services are still appropriate for selected cases.
Kezerashvili
Anna
A
Department of Medicine, Cardiology Division, Arrhythmia Service, Montefiore Medical Center, The Albert Einstein College of Medicine, New York, NY, USA.
Fisher
John D
JD
DeLaney
Jessica
J
Mushiyev
Savi
S
Monahan
Eileen
E
Taylor
Vanessa
V
Kim
Soo G
SG
Ferrick
Kevin J
KJ
Gross
Jay N
JN
Palma
Eugen C
EC
Krumerman
Andrew K
AK
D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D000768:Anesthesia, General / Q000401:mortality*; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D016292:Procedural Sedation; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007275:Injections, Intravenous / Q000706:statistics & numerical data; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009518:New York / Q000453:epidemiology; D010823:Physician Assistants / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam