Key result
Implantable cardioverter-defibrillator implantation under minimal sedation was feasible and did not influence visual analogue scale pain scores compared to short general anaesthesia.
Why the study?
Does local anaesthesia with minimal sedation maintain acceptable pain levels compared to short general anaesthesia in patients undergoing ICD implantation and defibrillation testing?
Cohort (n=118)
Does local anaesthesia with minimal sedation maintain acceptable pain levels compared to short general anaesthesia in patients undergoing ICD implantation and defibrillation testing?
ICD implantation with defibrillation testing under minimal sedation is feasible and results in similar patient-reported pain levels compared to short general anaesthesia.
May support minimal sedation for selected ICD patients; hypothesis-generating and requires randomized confirmation before practice change.
UNLABELLED: Aim In a prospective study, we tested the feasibility of implantable cardioverter-defibrillator (ICD) implantation under local anaesthesia (LA) with minimal sedation (MS) vs. short general anaesthesia (SGA) for defibrillation test (DT). METHODS AND RESULTS: We implanted ICDs in 118 patients between October 2002 and November 2003. Surgery was performed under LA with MS. Depending on the day of admission, patients had DT without SGA with a shock delivered when patient is unconscious (MS group, n = 73) or with short general anaesthesia (SGA group, n = 45). The patients were asked to rate the intensity of pain on a 10-point visual analogue scale (VAS) at the end of the implantation procedure and for the patient of MS group just after DT (VAS-DT). Visual analogue scale was not influenced by the type of anaesthesia (MS vs. SGA). Univariate analysis showed that NYHA >III, 3 leads implanted and an incomplete understanding of the explanation on the procedure were risk factors of VAS >4. Only understanding of the explanation on the procedure has an influence on pain in multivariate analysis. CONCLUSION: ICD implantation under MS even for DT is feasible and acceptable for the patient.
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Marquié et al. (2007) conducted a cohort in Patients requiring implantable cardioverter-defibrillator (ICD) (n=118). Local anaesthesia with minimal sedation vs. Short general anaesthesia was evaluated on Intensity of pain on a 10-point visual analogue scale (VAS). Implantable cardioverter-defibrillator implantation under minimal sedation was feasible and did not influence visual analogue scale pain scores compared to short general anaesthesia.
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