Bordeaux - general Anesthesia? Foley, gulp?

After reading Stephens thread about his Dr Natale experience with anesthesia / foley etc I became more curious as to what to expect in Bordeaux.

Do they use a general anesthesia there, or do I have a choice? It seems from the talk that a general is more fun from a number of different perspectives.

And now for the really frightening question...................should I expect a, gulp, foley.......??

I thought the worst of this was to be the TEE which I will have done in Calgary as a birthday present a few days before departure. I am trying to psyc myself up for it by pretending I am in training as a sword swallowing circus act. OK, I can do this.

But a foley. I am having a hard time conjuring up a circus act for a foley. I really hope the Frence have something more refined.

Ron

If you're on a GA, which I think you will be on, then I expect they will want to a Foley or some other catheter because of the of the length of the procedure and the fluids they're pumping into you - at least that's how it was explained to me.

Ron, They didn't give me a Foley at Bordeaux so you're probably ok there. I think I was put under but remember waking up near the end and listening to the conversation that was going on between Dr Hocini and another Dr. who was assisting in the placement of the pacing catheter. It may have been for only 20 minutes. tops Hard to say. I could feel the burns but made my best effort to endure them. Fortunately it wasn't long. After they were concerned about the amount of fluid that I had accrued and monitored my output until I had peed enough. I had to collect every urine output and place in a large glass bottle.

Bon chance

Adrian

Ron, I don't think they use General A as a rule in Bordeaux, though they may now as so many top EPs have switched to that form if anesthesia for the reason I outlined elsewhere.

Don't worry about the Foley, even if you need one, really 95% of the time it is no big deal at all. They use a Foley typically when they use an irrigated tip Thermocool catheter or similar design... Not sure what Drs. Jais and Haissaguerre use these days..

In any event, there is nothing to worry about with either Dr Natale's team or the Bordeaux team, with both you are in the best possible of hands ... really!

Shannon



Edited 1 time(s). Last edit at 05/07/2013 09:45PM by Shannon.

Ron,

I have never heard of anyone having a foley when in Bordeaux. If so, it would be the worst part of the procedure. Unless things have changed they like you to be somewhat aware of whats going on. And yes I also felt a couple of burns, but they just give you some more sedation. No big deal.
When I had a touch up done in Vancouver last year they do a tee for the entire procedure and totally knock you out.. Apart from the fact the touchup was unsuccessful, the only discomfort I had after was from the tube down my throat.

No worries, all will be fine,
Lou

I cannot see all this fear about the FOLEY, if it even happens. Normally it is a non event!

The foley is not really that big a deal, the relatively rare 'war story' was just that to cheer up Stephen and reassure him he was on the mend.

Two reasons Bordeaux doesn't use Foley's is that apparently, from all I have heard they do not use general anesthesia for most ablations preferring the original method of conscious sedation. Adrian you no doubt drifted in and out but were not really in general anesthesia if you could hear the docs talking during the procedure while you were in the EP lab.

Some who still use conscious sedation, feel that having a patient be able to feel some pain and moan or let them know can help tell them if they are getting too close around the esophagus, for example, or other structure they dont want to burn too much. However other studies have shown that patient response during conscious sedation is not at all a reliable indicator of whether or not the EP is using too much power or too much pressure in a given area as some people dont respond at all under conscious sedation and thus can give the EP a false sense of what he is doing if he if looking to their reaction while so out of it as a guideline.

There are other more reliable and objective ways to determine if you are in the right spot and using too much power or pressure , such as ICE imaging which, at least until through 2008 Bordeaux did not yet incorporate in ablations. A very skilled ablationist like Dr Jais and Haissaguerre can still do a perfect good ablation without the added window into whats happening in the left atrium that ICE can provide, but nevertheless it can be a real help to have that extra viewpoint and information it provides .. such as seeing in real time any slight bubbling coming off hte catheter tip indicating too much temperature which can possibly contribute to a silent TIA is not turned down.

The argument for general anesthesia is that the very slightly increased risk of anesthesia induced reaction is more than justified by the more consistent transmural burns achievable by most EPs, particularly so for those with less years and skill with a catheter, when they can precisely time their burns based on the controlled breath rate of the patient under general anesthesia.

Bordeaux may well use Carto-3 and ICE, or a similar competitive type system now, but I have not kept up to speed with their evolving process since I was there meeting with Dr. Haissaguerre in January 2008. Surely they have kept up with many of the technological advances that have happened since then in catheter design, imaging systems and programs as they are very busy investigating new tools as well as is Dr Natale's group and other leading EP groups around the US and Europe.

The main thing is the skill, knowledge and experience of the operator. The details of the equipment used and process are secondary to first putting yourself in the hands of the best ablationist you can arrange for yourself. All the high tech gear in the world in the hands of a relative beginner pales compared to an ablation done by a top gun even with just a good modern catheter and a Fluoroscope.

And yet, pairing a real maestro with the latest and best gear giving enhanced ability to see in real time as clearly as possible what is going on and do their work most efficiently makes lots of sense too. Nevertheless, its the man or woman behind the mask that is the ultimate key to the best outcomes.

Shannon

Shannon,

You're right no general anesthesia, just sedatives and lots of morphine. I felt some of the burns, but nothing afterwards. Ron, they're great nothing to worry about, and I had two ablations in six months.

Steve

Ron,

I did not have a Foley neither in Victoria nor in Bordeaux even though both procedures involved irrigated catheters.

Hans

THe use of the Foley increased after hte release of the original Thermocool catheter which was FDA approved in early 2009, but which pioneering docs like Dr Natale were using for ablations staring in the summer of 2008. I did not have a catheter on my first ablation as it turns out at Austin, but I was also among the first 20 patients Dr N had ablated with the then brand new Thermocool version 1.

Because of the long burn time my ablation required of more three times the typical ablation burn time ... mine was 117minutes of RF versus a typical at that time of 30min to 40min of actual RF time. AS a result of all the excess water that first generation Thermocool would dump in hte body per burn, I swelled up with almost 16 pounds of excess water weight over night which gave a kind of temporary psuedo-congestive heart failure symptoms with major shortness of breath due to all the edema.

I had to stay in the hospital for four extra days to drain all the water using lasix injections and potassium pills. As a result of such very early experiences with that new and improved catheter, they started inserting Foleys to help drain any excess water much faster and more efficiently.

These days they use the new generation Thermocool which only puts out half the volume of water as the original model and still does a better job cooling the tissue. As such, it is extremely rare for experiences like my first one to happen. And even I would not have had to go through that had I not had such a complex case that required so much work to eliminate all the AFIB sources.

The vast majority of the time the Foley is really a non-issue.

Shannon