Anaesthetic and sedative agents used for electrical cardioversion

Area of Science:

• Cardiology
• Anesthesiology
• Pharmacology

Background:

• Electrical cardioversion effectively restores normal sinus rhythm but requires sedation due to potential pain.
• Sedative agents for cardioversion should act quickly, wear off rapidly, and have minimal cardiovascular or respiratory side effects.

Purpose of the Study:

• To compare the safety, effectiveness, and adverse events of various anesthetic or sedative agents used in direct current cardioversion.
• To identify optimal drugs for cardioversion and assess the need for additional analgesia.

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL) up to March 2014 for randomized controlled trials and quasi-randomized studies.
• Included adult participants undergoing elective or emergency electrical cardioversion.
• Independently assessed trial quality and extracted data, with a third author resolving disagreements.

Main Results:

• Included 23 studies with 1250 participants, primarily comparing propofol with other agents like etomidate, midazolam, and thiopentone.
• Data could not be pooled due to variations in drug doses, administration times, outcome definitions, and high/unclear risk of bias.
• Key outcomes assessed included hypotension, apnea, participant recall, cardioversion success, and adverse events like nausea and pain.

Conclusions:

• Few studies reported statistically significant results for relevant outcomes.
• Most study authors found the compared agents adequate for cardioversion.
• Current evidence does not support changes to existing anesthetic practices for electrical cardioversion.