title: General anesthesia versus sedation for implantation of a biventricular pacing device for cardiac resynchronization therapy.
abstract: OBJECTIVE
  Heart failure carries significant risk for major noncardiac surgery. Whether this risk is transferable to minor surgery is less well-documented. Thus, the aim of this study was to assess the outcome of a contemporary cohort of heart failure patients undergoing cardiac resynchronization therapy (CRT) device insertion under general anesthesia or sedation.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Tertiary cardiac specialist hospital.
  
  
  METHODS
  Heart failure patients.
  
  
  METHODS
  CRT insertion under general anesthesia or sedation.
  
  
  RESULTS
  Anesthesia, heart failure, and outcome data were collected on a consecutive series of patients having CRT device insertion between 2002 and 2010. A total of 242 patients were managed by the anesthesia department during the study period. After exclusion criteria were applied, data for 183 patients were analyzed. Immediate perioperative (<24 hours) mortality was zero; 30-day mortality of 138 patients was 2.2%. One patient (0.5%) required unplanned intensive care admission. A comparison was made between the sedation (n = 76) group and the general anesthesia (GA) group (n = 107). When compared with the sedation group, the GA group had more intraoperative hypotension (26.2% versus 4.0%, p<0.00001). There was no difference between the GA and sedation groups with regard to 30-day mortality (1.4% versus 3.1%, p = 0.57), unplanned intensive care admission (0% versus 1.3%, p = 0.42), and length of stay in days (3 versus 3, p = 0.82).
  
  
  CONCLUSIONS
  The authors found that patients with heart failure undergoing CRT insertion with concurrent general anesthesia or sedation had minimal immediate perioperative risk and that there was no difference in postoperative outcome between general anesthesia and sedation.
authors.affiliation: Department of Anesthesia, Royal Brompton Hospital, London, United Kingdom. Electronic address: paultheron@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Theron
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Guha
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Lilian
authors.initials: L
authors.lastname: Mantziari
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Salman
authors.initials: S
authors.lastname: Salahuddin
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Anesthesia, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Sian
authors.initials: S
authors.lastname: Jaggar
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care / Q000706:statistics & numerical data; D023381:Endpoint Determination; D005260:Female; D006333:Heart Failure / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: biventricular pacing; cardiac resynchronization therapy; general anesthesia; heart failure; sedation