Key result
Same-arm propofol infusion during ICD implantation linked to ~6% anesthesia awareness from central venous bleeding.
Why the study?
Does administering continuous anaesthetic infusions in the same arm as the implantation side lead to awareness during ICD implantation?
Case Report (n=33)
Does administering continuous anaesthetic infusions in the same arm as the implantation side lead to awareness during ICD implantation?
To minimize the risk of awareness during ICD implantation, continuous intravenous infusions should be administered on the contralateral side to the implantation site.
Suggests caution with ipsilateral infusions during ICD implantation; hypothesis-generating and requires prospective confirmation before practice change.
Implantable cardioverter defibrillator implantation is performed under general anaesthesia. This report describes awareness or recall in two of 33 patients scheduled for implantation. After induction, anaesthesia was maintained using continuous infusions of propofol and atracurium and intermittent boluses of alfentanil. Propofol was given in the same arm as the implantation side. In these two patients propofol flowed out of the bleeding central venous access. To minimise the possibility of awareness, we advise that continuous infusions should be administered intravenously on the contralateral side to the implantation and that neuromuscular blocking agent be given by intermittent bolus injections.
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Moerman et al. (1995) conducted a case report in Implantable cardioverter defibrillator implantation (n=33). Continuous infusions of propofol and atracurium in the same arm as the implantation side was evaluated on Awareness or recall during anaesthesia. Awareness or recall during anaesthesia occurred in 2 of 33 patients undergoing implantable cardioverter defibrillator implantation due to propofol flowing out of the bleeding central venous access.
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