Sedation, pain management and resuscitation

Summary

Advances in minimally invasive percutaneous cardiovascular procedures have resulted in an increasing need for patients to be managed with sedative and analgesic medication outside the traditional operating room.

Sedation techniques, together with good pain relief, make it possible to perform these interventions and make it more acceptable to patients. Therefore, sedation and analgesia have become common practice in interventional cardiology. Many patients undergoing percutaneous coronary intervention have severe cardiovascular disease, obesity or pulmonary comorbidity and are therefore at high risk for hemodynamic instability.

These realities have resulted in more interventional cardiology practitioners being regularly exposed to critical care scenarios. The use of anxiolytic and analgesic medication is not without risk and it is not always easy to achieve the intended level of sedation. All personnel managing such situations must therefore have the necessary knowledge and skills to both recognise and manage adverse reactions safely. The catheter laboratory environment must contain all the relevant critical care equipment, including supplemental oxygen, suction, and equipment for airway support and bag-mask ventilation. Emergency protocols and training for cardiopulmonary resuscitation in the event of cardiac arrest or anaphylaxis must also be integrated into the skillset of practitioners.

Introduction

Over the last decades a growing...