In the cathlab several diagnostic and interventional procedures are performed. In fact, more and more, complex procedures are being performed using these minimally invasive approaches, with improved outcomes for patients. Pain, fear and anxiety are eased with sedation, at varying degrees, allowing patients to tolerate these procedures comfortably. However, there are specific challenges that need specific recommendations in this environment.
What are some of the common challenges faced by sedationists in cathlab?
- Managing airway in TOE where there is a shared airway between sedationist and professional performing the procedure.
- Targeting sedation to patient pain when the procedure causes periods of no pain and periods of short, intense pain.
- Using small boluses of drugs in longer procedures
- Patients with significant comorbidities
Specific sedation recommendations for the cathlab
In this paper, it was identified that anxiety can have harmful effects on compromised cardiovascular function by increasing heart rate and blood pressure. Anxiety may also interfere with the patient’s ability to cooperate during a procedure. Clinicians take patients’ anxiety levels into account when determining appropriate sedatives and sedation levels. To address sedation challenges, the British Cardiovascular Society recommends capnography as an element of safe sedation practice.
In this other recommendation, by the British Society of Echocardiography, conscious sedation is optional during TOE and the decision to opt for sedation must be made by the Primary Operator following discussion with the patient. Some patients prefer not to have conscious sedation. This has the advantage of a more rapid recovery post procedure with an earlier discharge time. Many patients prefer to have conscious sedation, although should understand that they will not receive a full anaesthetic.
It is mandatory that individuals who administer intravenous sedation should have received appropriate instruction and training. Click here to read the recommendations.
In this paper, it was identified that benzodiazepines and opioids result a modest reduction in pain, improved patient tolerability and reduced risk of radial artery spasm. The decision on whether to use sedation, and which agent(s) and dose, should be individualised based on patient factors, including need for oral antiplatelet therapy administration. Appropriate staffing and monitoring is essential.