Anesthesia

So I am going to be getting an ablation next month. Been in afib since July and rate controlled (ECV didn't work this time... had been cardiovereted many times before). I have spoken with 3 EPs and decide to go with the one that is tied in with my congenital heart docs. They can do the other Cath that they want to do.. and they are familiar with all my issues had a couple years ago.

Which brings me to my history. So 2 years ago I had a Cath and an aortic stent put in. (aortic stenosis). They started the Cath in twilight and then when we decided to do the stent they switched to general. I was sick as a dog for hours. They finally gave me some Ativan I guess (I was so out of it) and it stopped it. I ended up coughing a lot and had vocal cord paralysis. They had me do a CT and.. I had an aneurysm form. So two weeks after I went back in and they repaired it.. did a covered stent. I'm great and thank you Jesus the vocal cord paralysis abated. Before that second Cath they did give me some expensive pre-med for the nausea (I am on dofetildie so a lot of them you can't take). AND they did the whole thing in "twilight"..

Ok that was background. now the questions: The three EPs..

EP #1.. only does general

EP #2.. sometimes does general sometimes does twilight (my current EP)

EP#3.. she always does general but when I mentioned my issues she said .. hmm.. I might consider twilight. But she also agreed I should go to EP#2 at this juncture because of all my history at that hosptial.

So anyway------ any thoughts on anesthesia?? My EP (#2) said they will consider twilight with of course the potential to switch over and I will pre-medicate. But curious what others have done. I am going with EP#2 but I want to be versed in my conversations with him.

Thanks

There are pros and cons for GA as well as for sedation.
Many EP dislike having a conscious patient on the table, but some are used to. Many patients fear being conscious during the procedure, but some like it better than having hard times recovering from a GA.
IMO, both the patient and the EP have to feel confortable with their choice.
I've had two ablations with GA, two with CS.

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Pompon
There are pros and cons for GA as well as for sedation.
Many EP dislike having a conscious patient on the table, but some are used to. Many patients fear being conscious during the procedure, but some like it better than having hard times recovering from a GA.
IMO, both the patient and the EP have to feel confortable with their choice.
I've had two ablations with GA, two with CS.

Which did you prefer CS or GA?

By far, CS.
I've a hard time recovering from a GA. Sedation is not that hard on me.
Nevertheless, for a first procedure, which requires lots of burns in the L atrium (PVI), a GA might be better. I don't know for sure, since I've not experienced a CS for my PVI. For a touch-up, I wouldn't hesitate going for CS.

Thanks PomPon. you really put my mind at ease. When the other two said only general I got concerned that the other was 'bad,' what is CS? I am guessing twilight but what does it stand for? For the first part of my first Cath mentioned above I did poke my head up and said, "hey! whose doing this?!" (It is a teaching hospital). I recall nothing from the second...zzzz even though not general

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bettylou4488
what is CS? I am guessing twilight but what does it stand for?

conscious sedation

See: [www.revespcardiol.org]

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GeorgeN
what is CS? I am guessing twilight but what does it stand for?

conscious sedation

See: [www.revespcardiol.org]

THANKS! I do pretty good with propofol so I'm hopeful that will work out



Edited 1 time(s). Last edit at 09/20/2021 10:17AM by bettylou4488.

There are actually good reasons for using GA during an ablation. The anesthesiologist isn't just a passive bystander during the procedure. A good EP will at times want to control the movements your breathing causes, and that can't be done under CS. But the anesthesiologist can do it under GA. GA is also safer, particularly in the (unlikely) event of a major complication during the procedure. Personally, I would never agree to an ablation under CS.

I have never had one single adverse anything: 3 ablations 11 cardioversions over 16 yrs all GA. I wake up and in a few mins fine. Im 68 now
T

When in a teaching hospital it is worth noting that a doctor, not a resident, is doing the procedure and anesthesia. My doctor told me exactly what to say. But a resident ended up doing my GA and I woke up coughing and spitting out quite a lot of blood (I’m not on blood thinners because I am a bleeder somewhat). It’s 3 weeks post cryo ablation for me now and I still don’t feel 100%. Coughing only became much less and normal, 3 days ago. Teaching hospitals are good. But you have to specify who will do the orocedure(s) in my opinion.

I don’t think I even got a resident who assisted in the ecv at a teaching hospital…but I was his first ecv. I knew from experience that the back pad was too low-near waist, and I was ecv twice in vain. Another attending (hospitalist) dr speculated human error. Now I demand an attending to oversee everything. You have patient rights.

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bettylou4488
Thanks PomPon. you really put my mind at ease. When the other two said only general I got concerned that the other was 'bad,' what is CS? I am guessing twilight but what does it stand for? For the first part of my first Cath mentioned above I did poke my head up and said, "hey! whose doing this?!" (It is a teaching hospital). I recall nothing from the second...zzzz even though not general

I had my PVI under GA. This then meant three days of unbearable headache, moments of blurred vision or inability to find the words to speak.

For my first "touch-up" procedure, I asked the EP for a CS. He said "Yes, why not". But two months later, in the hospital, he said "No, we'll make a GA. You have to stay perfectly still". I wondered why he didn't replied that immediately when I asked for a CS... I thought it was a poor argument. I had a GA and this then meant three days of unbearable headache... and so on.

I've been ablated later by another EP who's comfortable with CS. The only thing that moved a lot during the procedure was my beating (fibrillating) heart. I was perfectly still. Painkillers were strong, I barely felt the burns. I was "floating".
I recovered easily.

IMO, there is no "good" or "bad". It's your choice (and the EP's).

I wouldn't ask for a CS if the EP isn't comfortable with that.

Thanks- yes I am aware. there are positives and negatives to this. Because of all my previous complications I don't think they will shimmy around what I ask for. I mean I guess I will have little control. LOL. Well I have prayed a lot about it and I do think this is the guy for me but I have one more appt with my congenital doc tomorrow over video and so I have 1001 questions for him.

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Sam3726
When in a teaching hospital it is worth noting that a doctor, not a resident, is doing the procedure and anesthesia. My doctor told me exactly what to say. But a resident ended up doing my GA and I woke up coughing and spitting out quite a lot of blood (I’m not on blood thinners because I am a bleeder somewhat). It’s 3 weeks post cryo ablation for me now and I still don’t feel 100%. Coughing only became much less and normal, 3 days ago. Teaching hospitals are good. But you have to specify who will do the orocedure(s) in my opinion.