Remifentanil-midazolam sedation provides hemodynamic stability and comfort during epicardial ablation of ventricular tachycardia.
Epicardial ablation of ventricular tachycardia (VT) presents multiple challenges for anesthetic management. General anesthesia lowers blood pressure, may interfere with arrhythmia mapping, and use of muscle relaxants precludes identification of the phrenic nerve. We describe a case in which remifentanil with minimal doses of midazolam was employed in a series of epicardial VT ablations and noninvasive programmed stimulations (NIPS), including 5 external cardioversions and discuss the advantages of this approach.
Mandel
Jeff E
JE
Department of Anesthesiology & Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. mandelj@uphs.upenn.edu
Hutchinson
Mathew D
MD
Marchlinski
Francis E
FE
D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004359:Drug Therapy, Combination; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D010880:Piperidines / Q000008:administration & dosage*; D000077208:Remifentanil; D017180:Tachycardia, Ventricular / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam