General Anesthesia Versus Conscious Sedation with Locoregional Anesthesia in S-ICD Implantation: A Monocentric Retrospective Analysis

Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a safe and effective alternative to the transvenous ICD (TV-ICD). Historically, S-ICD implantations have been performed under general anesthesia (GA). This study examines whether conscious sedation with locoregional anesthesia (CS-LA) is a safe and effective alternative to GA in S-ICD implantation. Methods 138 S-ICD implantations (90 CS-LA) at our institution between 2013-2020 were studied. Analgesic efficacy in the 24 post-operative hours was evaluated by Numerical Pain Rating Scale (NPRS) score and by total analgesic medication received. Safety was evaluated by comparing the incidence of significant adverse events (AE): hypotension <80 mmHg or requiring vasopressors, bradycardia <40 bpm, or desaturation <90% or requiring non-invasive ventilation maneuvers. Results Post-procedural pain at 15 minutes and 24 hours was significantly less in CS-LA (-0.90 (p=0.04) and -1.21 (p=0.004), respectively). Post-procedural opioid consumption was 10.64mg of per os morphine equivalents (p=0.046) lower in CS-LA. No significant difference in the likelihood ≥1 adverse event was noted (CS-LA OR 1.95 (95% CI [0.86, 4.40], p=0.11)). Conclusion S-ICD implantation under CS-LA was at least equivalent to GA in terms of analgesic efficacy and demonstrated a comparable safety profile. CS-LA represents a possible alternative to GA during S-ICD implantation in sites without readily available anesthesiologists.