AF ablation with sedation
The feasibility and safety of deep sedation during AF ablation has been
previously reported14-15. However, intravenous
sedation with an anesthetic agent such as propofol causes respiratory
suppression due to upper airway collapse, and the anesthetic depth is
associated with the respiratory status16.
As the sedation depth, anesthetic dosing was adjusted to maintain the
BIS value within a target range of 50-70 and actual average BIS value
before the ASV support was approximately 68, suggesting the sedation
depth was nearly moderate sedation12-13. In patients
under the moderate sedation depth, it is generally considered that no
interventions are required to maintain a patent airway and spontaneous
ventilation is adequate17. However, the present study
revealed that the 73% of the sedated patients had negative lowest LAP
value before the ASV support. That suggested that the LAP could become
negative even in patients under moderate sedation. During the procedure,
the sedation level often resulted in a deeper sedation level than
initially intended. Therefore, the fact that the risk of air intrusion
might change depending on the sedation continuum should be noted.
Additionally, the introduction and maintenance of the sedation was
performed with an intravenous propofol administration. For an
intravenous anesthetic agent during AF ablation, propofol, midazolam,
dexmedetomidine are commonly used. Out of those anesthetic agents,
dexmedetomidine has a relatively less propensity for the induction of an
upper air way collapse in comparison to propofol 12.
If dexmedetomidine is administered for the anesthesia, the prevalence of
a negative LAP under sedation could be smaller.