[Current Status and Issues of Sedation and Anesthesia in Cardiovascular Medicine]

Sedation or anesthesia is necessary in most of the patients undergoing catheter ablation of atrial fibrillation (AF) because of longer procedure time and interventions causing pain and discomfort such as cardioversion, administration of adenosine or RF applications to the posterior left atrium. In the United States, AF ablation is performed under general anesthesia by anesthesiologists or anesthesia nurses in half of the patients and other half is under conscious sedation by cardiologists or nurses. In Japan, however, a nationwide survey revealed more than 95% of patients underwent AF ablation under conscious or deep sedation and most of them are performed by cardiologists who also have other responsibility. Current problems include a difficulty in management of respiration in patients with sleep apnea that often coincide with AF. Continuous positive airway pressure combined with nasal or oral airway and jaw elevation device is often used. Frequencies of monitoring of SP(O2), arterial blood pressure, BIS, and Et(CO)2 were 99%, 79%, 13.2% and 2% of patients, respectively, which suggests monitoring of consciousness level and ventilation may be insufficient Japanese Heart Rhythm Society started educational activities for safe sedation by themselves.