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Case Report
have shown that propofol and isoflurane anesthesia did
not alter sinoatrial or atrioventricular node function and
were equally suitable in pediatric patients undergoing
radiofrequency catheter ablation of supraventricular
tachycardia .[12,13] However, compared with isoflurane
anesthesia, propofol anesthesia significantly reduced
the incidence of postoperative nausea and vomiting in
children with supraventricular tachycardia[14]. Sevoflurane
decreased the conduction time of the sinoatrial node
and the conduction interval between the atria and the
Hiss bundles, and partially affected the properties of the
accessory pathway, although these changes were not
clinically important for ablation of Wolff-Parkinson-White
syndrome[15,16].
Intravenous anesthetics such as sufentanil, alfentanil,
midazolam and propofol did not significantly affect the
electrophysiological properties of anomalous or normal
atrioventricular conduction pathways[17,18]. According to
the clinical researches, propofol has no effect on QTc, but
sevoflurane could prolong QTc in adult[19,20]. High dose
(0.4µg/kg/min) of remifentanil prolonged both sinus node
recovery time and sinoatrial conduction time, but had
no effect on the atrial-His interval[21]. Thus, this drug may
prolonged the time of atrial electrical activity mapping
and then produced an increase in the time of catheters
permanence in the left atrium, but even high dose of
remifentanil did not lead to changes in the outcome of
ablation including the total time of the procedure and the
incidence of recurrence after three months in patient with
AF[9]. Therefore, TIA with propofol and remifentanil could
meet the need of early arousal, low possibility of changing
atrial excitability threshold, and low intensity of painful
stimuli during the procedure.
TCI technique is increasingly used in anesthesia to
accurately control the concentrations of propofol and
remifentanil in the plasma. The administration of drugs
via TCI allows the achievement of target-concentration
defined without overshoot and overdosing, which is
common when using manual infusion .[22] Compared
Laboratory and Clinical CInavseestRigeaptoiortn
123
with manually controlled administration of remifentanil,
TCI resulted in a decrease in propofol dose, and a
lower incidence in apnea and respiratory depression[23].
Generally, the propofol TCI according to the BIS and MAP
criteria were made for most patients. Anesthesia guided
by BIS within the recommended range (40 to 60) could
improve anesthetic delivery, and reduce the requirement
for propofol and the postoperative recovery time .[24]
In this report, TCI of propofol and remifentanil guided
by BIS (40 to 50) was performed for ablation of AF. The
anesthesia induction was fast and comfortable, smooth,
recovery quickly after anesthesia, which did not cause any
severe adverse events such as hypotension, hypertension,
intraoperative awareness and delayed recovery et al. With
the help of TIA, the cardiologists successfully performed
radiofrequency catheter ablation of AF and restored sinus
rhythm in the patient with long-lasting persistent AF during
TIA.
In summary, our data demonstrated that combination
of propofol and remifentanil target-controlled infusion
with LMA insertion may become an attractive alternative
for radiofrequency catheter ablation of AF. Incidence of
adverse side effects of propofol and remifentanil is low if
above standard monitored measures are followed.
References
1 Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors
for atrial fibrillation in a population-based cohort. The
Framingham Heart Study. JAMA, 1994, 271(11):840-844.
2 Cappato R, Calkins H, Chen SA, et al. Worldwide survey on the
methods, efficacy, and safety of catheter ablation for human
atrial fibrillation. Circulation, 2005, 111(9):1100-1105.
3 Knackstedt C, Schauerte P, Kirchhof P. Electro-anatomic mapping
systems in arrhythmias. Europace, 2008, 10(Suppl 3):iii28-34.
4 Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS
expert consensus statement on catheter and surgical ablation of
atrial fibrillation: recommendations for patient selection,
procedural techniques, patient management and follow-up,
definitions, endpoints, and research trial design. J Interv Card
Electrophysiol, 2012, 33(2):171-257.
71 FAM 2014 Jan/Feb Vol.21 Issue 1