WJCS  Vol.4 No.11 , November 2014
Anaesthetic Challenges in Cardiac Interventional Procedures
Abstract: The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different patient categories, complications and safety issues. Collaboration and planning between cardiologist and anaesthesiologist are required for both patient safety and procedural success. This review aims to discuss procedures performed in interventional cardiology and the importance of anaesthesiologists in managing such patients. Percutaneous interventions are being increasingly performed in adult as well as in pediatric patients. Procedures are usually done under mild to moderate sedation. General anaesthesia is required in certain conditions and also in pediatric patients. Knowledge of echocardiography, individual disease condition and fluoroscopy is important. Anaesthesiologists are assuming an increasingly important role in the multidisciplinary management of complex patients and interventions. A comprehensive understanding of procedures is essential to provide a high level of anaesthetic care and maintain patient safety.
Cite this paper: Thangavel, P. , Muthukumar, S. , Karthekeyan, B. , Vakamudi, M. , Ashokkumar, Nayagam, H. and Sambandham, K. (2014) Anaesthetic Challenges in Cardiac Interventional Procedures. World Journal of Cardiovascular Surgery, 4, 206-216. doi: 10.4236/wjcs.2014.411030.

[1]   Braithwaite, S., Kluin, J., Buhre, W.F. and de Waal, E. (2010) Anaesthesia in the Cardiac Catheterization Laboratory. Current Opinion in Anaesthesiology, 23, 507-512.

[2]   Shook, D.C. and Savage, R.M. (2009) Anaesthesia in the Cardiac Catheterization Laboratory and Electrophysiology Laboratory. Anaesthesiology Clinics, 27, 47-56.

[3]   Hayman, M., Forrest, P. and Kam, P. (2012) Anaesthesia for Interventional Cardiology. Journal of Cardiothoracic and Vascular Anaesthesia, 26, 134-147.

[4]   Shook, D.C. and Gross, W. (2007) Offsite Anaesthesiology in the Cardiac Catheterization Laboratory. Current Opinion in Anaesthesiology, 20, 352-358.

[5]   (2002) American Society of Anaesthesiologists. Task Force on Sedation and Analgesia by Non Anaesthesiologists. Practice Guidelines for Sedation and Analgesia by Non Anaesthesiologists. Anaesthesiology, 96, 1004-1017.

[6]   (2003) Statement on Nonoperating Room Anaesthetizing Locations Committee of Origin: Standards and Practice Parameters Approved by the ASA House of Delegates on October 15, 2003.

[7]   Klemm, H.U., Steven, D., Johnsen, C., et al. (2007) Catheter Motion during Atrial Ablation Due to the Beating Heart and Respiration: Impact on Accuracy and Spatial Referencing in Three-Dimensional Mapping. Heart Rhythm, 4, 587- 592.

[8]   Di Biase, L., Conti, S., Mohanty, P., et al. (2011) General Anaesthesia Reduces the Prevalence of Pulmonary Vein Reconnection during Repeat Ablation When Compared with Conscious Sedation. Results from a Randomized Study. Heart Rhythm, 8, 368-372.

[9]   Viskin, S. (1999) Long QT Syndromes and Torsade de Pointes. Lancet, 354, 1625-1633.

[10]   Kang, J., Reynolds, W.P., Chen, X.L., et al. (2006) Mechanisms Underlying the QT Interval-Prolonging Effects of Sevoflurane and Its Interactions with Other QT-Prolonging Drugs. Anaesthesiology, 104, 1015-1022.

[11]   Higashijima, U., Terao, Y., Ichinomiya, T., Miura1, K., Fukusaki, M. and Sumikawa, K. (2010) A Comparison of the Effect on QT Interval between Thiamylal and Propofol during Anaesthetic Induction. Anaesthesia, 65, 679-683.

[12]   Serruys, P.W., Kutryk, M.J. and Ong, A.T. (2006) Coronary Artery Stents. The New England Journal of Medicine, 354, 483-495.

[13]   Moses, J.W., Leon, M.B., Popma, J.J., Fitzgerald, P.J., Holmes, D.R. and O’Shaughnessy, C., et al. (2003) Sirolimus-Eluting Stents versus Standard Stents in Patients with Stenosis in a Native Coronary Artery. The New England Journal of Medicine, 349, 1315-1323.

[14]   Grube, E., Silber, S., Hauptmann, K.E., Mueller, R., Buellesfeld, L., Gerckens, U. and Russell, M.E. (2003) TAXUS I: Six and Twelve Month Results from a Randomized Double Blind Trial on a Slow Release Paclitaxel-Eluting Stent for De Novo Coronary Lesions. Circulation, 107, 38-42.

[15]   Arrich, J., Holzer, M., Havel, C., Müllner, M. and Herkner, H. (2012) Hypothermia for Neuroprotection in Adults after Cardiopulmonary Resuscitation. Cochrane Database of Systematic Reviews, Published Online.

[16]   King, T.D., Thompson, S.L., Steiner, C. and Mills, N.L. (1976) Secundum Atrial Septal Defect. Non Operative Closure during Cardiac Catheterization. Journal of the American Medical Association, 235, 2506-2509.

[17]   Hollinger, I. and Mittnacht, A. (2009) Cardiac Catheterization Laboratory: Catheterization, Interventional Cardiology and Ablation Techniques for Children. International Anesthesiology Clinics, 47, 63-99.

[18]   Martinez, M.W., Mookadam, F., Sun, Y. and Hagler, D.J. (2007) Transcatheter Closure of Ischemic and Post Traumatic Ventricular Septal Ruptures. Catheterization and Cardiovascular Interventions, 69, 403-407.

[19]   Garay, F., Cao, Q.L. and Hjazi, Z.M. (2006) Percutaneous Closure of Post Myocardial Infarction Ventricular Septal Defect. Journal of Interventional Cardiology, 19, 67-72.

[20]   Cribier, A., Eltchaninoff, H., Bash, A., Borenstein, N., Tron, C., Bauer, F., et al. (2002) Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis: First Human Case Description. Circulation, 106, 3006-3008.

[21]   Block, P.C. (2006) Percutaneous Transcatheter Repair for Mitral Regurgitation. Journal of Interventional Cardiology, 19, 547-551.

[22]   Feldman, T. (2007) Percutaneous Mitral Valve Repair. Journal of Interventional Cardiology, 20, 488-494.

[23]   Nobuyoshi, M., Arita, T., Shirai, S., Hamasaki, N., Yokoi, H., Iwabuchi, M., et al. (2009) Percutaneous Balloon Mitral Valvuloplasty: A Review. Circulation, 119, e211-e219.

[24]   Kar, B., Adkins, L.E., Civitello, A.B., Loyalka, P., Palanichamy, N., Gemmato, C.J., et al. (2006) Clinical Experience with the Tandem Heart Percutaneous Ventricular Assist Device. Texas Heart Institute Journal, 33, 111-115.

[25]   Pretorius, M., Hughes, A.K., Stahlman, M.B., Saavedra, P.J., Deegan, R.J., Greelish, J.P. and Zhao, D.X. (2006) Placement of the Tandem Heart Percutaneous Left Ventricular Assist Device. Anesthesia & Analgesia, 103, 1412-1413.

[26]   Spina, R., Forrest, A.P., Adams, M.R., Wilson, M.K., Ng, M.K. and Vallely, M.P. (2010) Veno-Arterial Extracorporeal Membrane Oxygenation for High-Risk Cardiac Catheterisation Procedures. Heart, Lung and Circulation, 19, 736-741.

[27]   Meyer, J., Mollhalt, I., Seiter, T., Brunn, J., Rotker, J., Block, M. and Prien, T. (1996) Cardiac Output Is Not Affected during Intraoperative Testing of the Automatic Implantable Cardioverter Defibrillator. Journal of Cardiovascular Electrophysiology, 7, 211-216.

[28]   Gilbert, T.B., Gold, M.B., Shorofsky, S.R., Hasnain, J.U., Ferguson, M.K. and Foster, A.H. (2002) Cardiovascular Responses to Repetitive Defibrillation during Implantable Cardioverter-Defibrillator Testing. Journal of Cardiothoracic and Vascular Anesthesia, 16, 180-185.

[29]   Farooqi, F.M., Talsania, S., Hamid, S. and Rinaldi, C.A. (2010) Extraction of Cardiac Rhythm Devices: Indications, Techniques and Outcomes for the Removal of Pacemaker and Defibrillator Leads. International Journal of Clinical Practice, 64, 1140-1147.

[30]   Masura, J., Walsh, K.P., Thanopoulous, B., Chan, C., Bass, J., Goussous, Y., et al. (1998) Catheter Closure of Moderate- to Large-Sized Patent Ductus Arteriosus Using the New Amplatzer Duct Occluder: Immediate and Short-Term Results. Journal of the American College of Cardiology, 31, 878-882.