Sedation and analgesia in the cardiac electrophysiology laboratory: a national survey of electrophysiologists investigating the who, how, and why?
OBJECTIVE
To investigate sedation and anesthesia trends and practice patterns for procedures in the cardiac electrophysiology laboratory (EPL).


METHODS
A survey distributed by e-mail.


METHODS
US teaching hospitals with a training program in cardiac electrophysiology.


METHODS
Cardiologists involved in procedures in the electrophysiology laboratory of academic electrophysiology programs.


METHODS
A survey was e-mailed to the selected programs. The survey questions included the use of anesthesia professional (MD/CRNA) and nonanesthesia professional (RN) services, medications administered, commonly performed airway interventions, satisfaction with anesthesia services, and reasons that anesthesia professionals are not used when RNs administer sedation.


RESULTS
Of the 95 academic electrophysiology programs surveyed, there were 38 responses (40%). The majority (71%) of respondents used a combined model of care with both anesthesia professional care and nonanesthesia professional (RN) sedation, although there were EPLs that had exclusively anesthesia professional (n = 6) and exclusively nonanesthesia professional coverage (n = 5); 26.3% of respondents answered that care by an anesthesia professional was warranted most (>50%) of the time regardless of their current care model. The main reasons cited for having RN-administered sedation were the lack of availability of anesthesia professionals, difficulty with scheduling, and increased operating room suite turnover times. Programs using exclusively RN sedation (13%) reported all levels of anesthesia including general anesthesia (patient unarousable to repeated deep stimulation).


CONCLUSIONS
This survey suggested that sedation for EPL procedures was sometimes allowed to progress to deep sedation and general anesthesia and that selection of anesthesia provider frequently was made based on availability, operating room efficiency, and economic reasons before patient safety issues. The implications of the survey must be explored further in a larger-scale sample population before more definitive statements can be made, but results suggested that sedation in the EPL is an area that would benefit from updated guidelines specific to the current practice as well as attention from the anesthesia community to address the deficiency in provision of anesthesia care.
Department of Anesthesiology, Mayo Clinic, Phoenix, AZ 85054, USA. gaitan.brantley@mayo.edu
Brantley Dollar
BD
Gaitan
Terrence L
TL
Trentman
Sharon L
SL
Fassett
Jeff T
JT
Mueller
Gregory T
GT
Altemose
D000698:Analgesia; D000758:Anesthesia / Q000639:trends*; D054849:Cardiac Electrophysiology; D016292:Procedural Sedation / Q000639:trends*; D003625:Data Collection; D006784:Hospitals, Teaching; D006801:Humans; D007755:Laboratories, Hospital; D010818:Practice Patterns, Physicians'