Anesthesia? September 07, 2018 04:20AM |
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Re: Anesthesia? September 07, 2018 12:40PM |
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Carey
Conscious sedation for an ablation makes no sense to me whatsoever. I would never even consider it. The safety reasons alone are enough to rule it out.
Re: Anesthesia? September 07, 2018 12:58PM |
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Re: Anesthesia? September 07, 2018 06:23PM |
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Pompon
Would you elaborate a little?
Re: Anesthesia? September 07, 2018 06:24PM |
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Re: Anesthesia? September 07, 2018 06:41PM |
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Re: Anesthesia? September 08, 2018 01:22AM |
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wolfpack
The standard in the US is pretty much general anesthesia (GA). Maybe the Cleveland Clinic still does sedation. You really don’t want to able to move with red hot catheters in your heart. Nothing good can come of that.
Re: Anesthesia? September 08, 2018 03:11AM |
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Re: Anesthesia? September 08, 2018 11:35AM |
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Pompon
I agree with your answer, Carey, but the EP saying he wants a GA because the patient must stay perfectly still doesn't tell the truth. There are good reasons to go for a GA, as you wrote, but not that one, IMO.
Re: Anesthesia? September 08, 2018 11:38AM |
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Sam
Carey clearly was referring to me. After my Bordeaux ablation I had a degree of Effusion (very common after an ablation) which was clearing up nicely three days later.
Re: Anesthesia? September 08, 2018 12:54PM |
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Carey
Carey clearly was referring to me. After my Bordeaux ablation I had a degree of Effusion (very common after an ablation) which was clearing up nicely three days later.
Glad to hear it cleared up for you but no, it's not very common. Pericardial effusion is a rare complication. If it's common for an EP to see it in his patients, I wouldn't go near that EP.
Re: Anesthesia? September 08, 2018 12:56PM |
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Carey
I agree with your answer, Carey, but the EP saying he wants a GA because the patient must stay perfectly still doesn't tell the truth. There are good reasons to go for a GA, as you wrote, but not that one, IMO.
Of course it's the truth. Although ablations can be done with conscious sedation that doesn't change the fact that a conscious patient presents an increased risk of movement. Even though you were aware that you shouldn't move and remained vigilant not to do so, that doesn't mean everyone can do that reliably. And anyone, no matter how careful, might cough, sneeze or reflexively withdraw from pain.
Re: Anesthesia? September 08, 2018 01:39PM |
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Pompon
I agree with your answer, Carey, but the EP saying he wants a GA because the patient must stay perfectly still doesn't tell the truth. There are good reasons to go for a GA, as you wrote, but not that one, IMO.
Of course it's the truth. Although ablations can be done with conscious sedation that doesn't change the fact that a conscious patient presents an increased risk of movement. Even though you were aware that you shouldn't move and remained vigilant not to do so, that doesn't mean everyone can do that reliably. And anyone, no matter how careful, might cough, sneeze or reflexively withdraw from pain.
If it adds so much risk, why do they use this technique in Bordeaux ? I'm sure a GA adds its own risks too, so I guess it's somewhat equal. If one choice proved to be really better, I think it's what they would go for nearly everywhere.
Re: Anesthesia? September 08, 2018 01:51PM |
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Brian_og
I agree with your answer, Carey, but the EP saying he wants a GA because the patient must stay perfectly still doesn't tell the truth. There are good reasons to go for a GA, as you wrote, but not that one, IMO.
Of course it's the truth. Although ablations can be done with conscious sedation that doesn't change the fact that a conscious patient presents an increased risk of movement. Even though you were aware that you shouldn't move and remained vigilant not to do so, that doesn't mean everyone can do that reliably. And anyone, no matter how careful, might cough, sneeze or reflexively withdraw from pain.
If it adds so much risk, why do they use this technique in Bordeaux ? I'm sure a GA adds its own risks too, so I guess it's somewhat equal. If one choice proved to be really better, I think it's what they would go for nearly everywhere.
From the study noted above
Conclusions: Using GA for PeAF ablation is both clinically and financially effective. Patient immobility leads to improved accuracy of mapping and catheter stability, and optimizes lesion quality.
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I'm sure a GA adds its own risks too
Re: Anesthesia? September 08, 2018 04:19PM |
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Re: Anesthesia? September 08, 2018 05:11PM |
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mwcf
Serious question. Is PE a very rare occurrence in the top US centres as opposed to elsewhere in the world?
Re: Anesthesia? September 08, 2018 07:03PM |
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jpeters
Nothing at all related to local anaesthsia
. Pericardial effusion (PE) is certainly one of the most frequently observed complications during AF ablation.
Pericardial effusion was detected in 19 (14.2%) of 133 patients.
. Ablation was performed under general anaesthesia
[www.ncbi.nlm.nih.gov]
Re: Anesthesia? September 08, 2018 07:09PM |
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Pompon
If it adds so much risk, why do they use this technique in Bordeaux ? I'm sure a GA adds its own risks too, so I guess it's somewhat equal. If one choice proved to be really better, I think it's what they would go for nearly everywhere.
Re: Anesthesia? September 08, 2018 07:10PM |
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jpeters
From "Ten things to expect after AF ablation", John Mandrola:
"A majority of patients have chest pain for a few days after the procedure. The severity of the pain varies a lot. Most often, it hurts to take a deep breath or cough. Some patients say their chest feels tight. These symptoms are likely due to irritation of the lining of the heart, called the pericardium"
Re: Anesthesia? September 08, 2018 07:24PM |
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Carey
I'm quite sure the risks aren't equalized by the risks involved with GA or GA wouldn't be used for elective procedures like colonoscopy, and yet it is. Extensively.
Right, but inflammation probably triggers a degree of effusion ??Quote
Carey
Pericardial irritation isn't a pericardial effusion.
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Carey
That's an eight-year old article that must have used very broad criteria for identifying pericardial effusion.
Re: Anesthesia? September 08, 2018 07:39PM |
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Re: Anesthesia? September 08, 2018 07:45PM |
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Carey
I can't speak for why Bordeaux does what they do, but I would point out that not using GA is cheaper since no anesthesiologist is required.
Re: Anesthesia? September 09, 2018 03:20AM |
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Re: Anesthesia? September 09, 2018 04:47AM |
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Pompon
Carey, when you're speaking about the cost of the procedure, I think we can't make a fair comparison between different countries, because health insurance systems are different too. There may exist motivations, other than strictly medical, to make the procedures cheaper or costlier.
I clearly remember the agitation in the room before my GA, there were half a dozen people or so all around, until a mask were applied on my face. Then, a gentle voice pronounced my name close to my ear and it was done. I didn't know the heck what happened other than I was told later. The following hours and days were painful. I had nearly continuous headache and memory troubles.
Comparatively, the recent touch-up was nearly a pleasure. There were merely three to four people around me, in a relaxed mood, the EP quietly explaining what was happening, the burns he made and asking if I was fine. It was incredibly interesting to feel the changes in my HR, the afib coming and going. I recovered easily, with no headache and clear memory.
Re: Anesthesia? September 09, 2018 11:40AM |
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