Midazolam addition to analgosedation for pulmonary vein isolation may increase risk of hypercapnia and acidosis. (15th May 2018)

• Record Type: Journal Article
• Authors: Kaess, Bernhard M.; Feurich, Florian; Bürkle, Gerd; Ehrlich, Joachim R.
• Is Part Of: International journal of cardiology. Volume 259(2018)
• Page Start: 100
• Page End: 102
• Publication Date: 2018-05-15
• Subjects: Analgosedation -- Pulmonary vein isolation -- Midazolam -- Propofol hypocapnia; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.01.044
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Pulmonary vein isolation (PVI) is generally performed under analgosedation, but sedation protocols vary and no optimal protocol has been defined. We investigated procedural, respiratory and hemodynamic parameters in patients undergoing PVI using analgosedation either with or without midazolam. Methods: In a prospective observational study, we compared n = 43 consecutive patients (54% male, mean age 62 years) undergoing PVI using analgosedation either with or without midazolam added to propofol and fentanyl. A priori defined outcome measures were propofol dose, hypotension (systolic blood pressure <100 mm Hg or >30 mm Hg drop from baseline), acidosis (pH < 7.30), hypercapnia (pC02 > 55 mm Hg) and hypoxemia (transdermal oxygen saturation < 90%). Results: Patients in the midazolam group (n = 22) received a mean dose of 3 ± 1.5 mg midazolam and required less propofol than those in the no-midazolam group (n = 21, 473 ± 189 mg vs. 618 ± 219 mg, p = .03). Incidence of hypotension did not differ between groups (54.5% vs. 61.9%, p = .63). Acidosis was more frequent in the midazolam group (63.6% vs. 28.6%, p = .03), as was hypercapnia (50% vs. 14.3%, p = .03) while occurrence of hypoxemia did not differ between groups (22.7 vs. 33.3%, p = .5). Conclusion: Patients receiving midazolam had a more than doubled risk of respiratory depression as mirrored by hypercapnia and acidosis, but not hypoxemia. These observations may help in choosing an analgosedation and monitoring protocol for PVI. Highlights: Midazolam addition to propofol and fentanyl for pulmonary vein isolation led to respiratory depression (acidosis and hypercapnia, not hypoxia). Midazolam did not reduce the incidence of hypotension Midazolam addition to propofol and fentanyl should therefore be avoided in the majority of patients undergoing pulmonary vein isolation