title: Procedural sedation with dexmedetomidine during ablation of atrial fibrillation: a randomized controlled trial.
abstract: OBJECTIVE
  Procedural sedation by non-anaesthesiologists with GABAergic anaesthetics has the potential risk of fatal respiratory depression. Dexmedetomidine works its sedative action via α2-adrenergic receptors, and is less associated with respiratory depression. We tested the usability of dexmedetomidine as a procedural sedative during ablation of atrial fibrillation (AF).
  
  
  RESULTS
  Consecutive patients were randomized to be treated with dexmedetomidine (n = 43) or thiamylal (n = 44) as sedatives during AF ablation. Apnoeic and body movement events were monitored using a novel portable respiratory monitor, the SD-101, during the procedure. Although the majority of the patients receiving dexmedetomidine required rescue sedations with thiamylal, the respiratory disturbance index (RDI) defined as the total number of sleep-disordered breathing events divided by the recording time (10.4 ± 5.1 vs. 18.2 ± 8.1 events/h; P < 0.0001) and movement index defined as the number of body movement events per hour (7.6 ± 6.1 vs. 11.0 ± 5.5 events/h; P = 0.0098) were both significantly lower in the dexmedetomidine arm than in the thiamylal arm. A multivariate linear regression analysis including potential factors revealed that dexmedetomidine vs. thiamylal was solely and independently associated with the RDI (β = -0.62; P = 0.0031). The occurrence of hypotension [9 (21%) vs. 4 (9%); P = 0.14] and bradycardia [4 (9%) vs. 4 (9%); P = 1.0] were similar in the patients with dexmedetomidine and thiamylal.
  
  
  CONCLUSIONS
  Procedural sedation with dexmedetomidine may assure safety and patient immobility during AF ablation, and therefore may be a potential alternative for that with GABAergic anaesthetics.
authors.affiliation: Department of Cardiology, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan Department of Cardiology, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan rjrgw059@ybb.ne.jp.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sairaku
authors.affiliation: Department of Cardiology, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Department of Cardiology, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Hirayama
authors.affiliation: Department of Cardiology, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Department of Cardiology, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466-8650, Japan.
authors.forename: Monami
authors.initials: M
authors.lastname: Ando
authors.affiliation: Department of Cardiology, Graduate School of Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001919:Bradycardia / Q000139:chemically induced; D017115:Catheter Ablation / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007022:Hypotension / Q000139:chemically induced; D007564:Japan; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009043:Motor Activity / Q000187:drug effects; D015999:Multivariate Analysis; D012119:Respiration / Q000187:drug effects; D012307:Risk Factors; D012890:Sleep / Q000187:drug effects; D013840:Thiamylal / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D006993:Hypnotics and Sedatives; D013840:Thiamylal; D020927:Dexmedetomidine
keywords: Ablation of atrial fibrillation; Dexmedetomidine; Patient movement; Respiratory disturbance index