Page 15 - 麻醉与监护论坛2016年第4期
P. 15
Case Report
were used for peripheral venous infusion and invasive was 4.0mg/kg/h, while that of remifentanil was 0.1µg/kg/h.
arterial blood pressure monitoring, respectively. At the end of procedure, the infusions of remifentanil and
Monitoring included a 12-lead electrocardiogram, heart propofol were discontinued. The patient was extubated
rate, MAP, pulse oximetry, PETCO2, BIS to assess anesthetic when the concentration of propofol at the effector site
depth. Before induction, the patient was preoxygenated reached 1.0µg/mL and she had shown good awareness.
for 3min. Anesthesia was induced with intravenous TCI After ablation of AF, the sinus rhythm was restored and the
of propofol with a target of 3μg/mL, intravenous TCI of patient was transferred to the post anesthetic care unit.
remifentanil with a target of 3ng/mL, and intravenous
bolus of rocuronium 0.2mg/kg. Her verbal response was Discussion
lost when the concentration of propofol at the effector site
reached 0.8µg/mL and of remifentanil 2ng/mL as well as The implication of ablation for the curative treatment
the bispectral index was 70. Then a laryngeal mask airway of AF has increased significantly due to its safeness and
(LMA) was inserted until the concentration of propofol at effectiveness. The radiofrequency ablation therapy of AF
the effector site reached 2µg/mL and the bispectral index can provide the chance of permanent cure with significant
was 40. After that, mechanical ventilation was performed improvement in quality of life in patients[6]. Although
to maintain PETCO2 between 35 and 40 mmHg. different sedation techniques have been proposed by the
North American Society of Pacing and Electrophisiology
During the procedure, the concentrations of propofol (NASPE)[7,8], there is no literature that recommends the
and remifentanil were adjusted according to BIS and best anesthetic technique for anesthetists.
MAP. Anesthesia was maintained with TCI of propofol
and remifentanil at adequate concentrations to maintain In the clinical practice, it is commonly performed
BIS between 40 and 50, and a maximal 20% variation under deep sedation or general anesthesia. Studies
in MAP. An irrigated-tip ablation catheter and a circular have shown that general anesthesia can provide smaller
mapping catheter were positioned in the left atrium (LA) respiratory changes and greater immobility of the patient,
after double transseptal puncture under echocardiogram not causing respiratory complications such as hypoxia,
guidance. Angiography of the LA and the pulmonary cough and upper respiratory obstruction when compared
veins was performed in adenosine-induced asystole. with deep sedation .[9,10] General anesthesia with LMA
The geometry of the LA was reconstructed using a insertion allows safe and sufficient ventilation with or
3D-Mapping-System. Circumferential pulmonary vein without muscle relaxants. Studies have shown that
isolation was carried out using an irrigated-tip catheter low-dose muscle relaxant facilitates LMA insertion and
and a Stockert RF generator. Endpoint was the complete decrease the incidence of postoperative sore throat[11]. In
isolation of pulmonary veins verified by the circular this report, low-dose rocuronium (0.2mg/kg) was used to
catheter. Additionally, systematic heparinization was facilitates the LMA insertion and there were no increase
continued to maintain activated coagulation time between in the patient’s blood pressure and heart rate during the
250 seconds and 300 seconds. During the procedure, insertion.
anesthesia was maintained at an effect-site concentration
of 1.8-2.5µg/mL for propofol and 2-4ng/mL for Both inhalational anesthesia and intravenous
remifentanil with 100% oxygen, according to the patient’s anesthesia has been performed for ablation of AF. Although
vital signs. The total propofol and remifentanil infusion various studies have compared propofol and isoflurane
time was 250 minutes. A mean infusion rate of propofol anaesthesia in patients undergoing radiofrequency
ablation, results have failed to demonstrate significant
clinical differences between the two agents. Studies
Laboratory and Clinical ICnavseestRigeaptoiornt 70 FAM 2014 Jan/Feb Vol.21 Issue 1
123
