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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

396
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
396
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

322
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
322

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Related Experiment Video

Updated: May 10, 2025

Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation
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COOPERATIVE-PFA: A Three-Arm Randomized Controlled Trial.

Veronika Sochorová1, Veronika Kunštátová1, Pavel OsmanČík2

  • 1Department of Anesthesia and Intensive Care Medicine, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic (V.S., V.K., F.D., P.W.).

Circulation
|April 27, 2025
PubMed
Summary
This summary is machine-generated.

Ketamine-remimazolam deep analgosedation (DAS) is superior for atrial fibrillation (AF) pulsed-field ablation (PFA), significantly reducing hypoxemia and hypotension compared to propofol-opioid regimens. This optimized sedation minimizes adverse events during PFA procedures.

Keywords:
atrial fibrillationcatheter ablationdeep sedationgeneral anesthesia

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Medical Devices

Background:

  • Pulsed-field ablation (PFA) for atrial fibrillation (AF) necessitates deep analgosedation (DAS) or general anesthesia (GA).
  • General anesthesia requires airway management, unlike DAS, prompting investigation into optimal sedation strategies.
  • This study compares ketamine-remimazolam DAS and propofol-opioid total intravenous anesthesia (TIVA) against propofol-opioid DAS for PFA.

Purpose of the Study:

  • To determine the optimal sedation regimen for PFA procedures.
  • To compare sedation-related adverse events between ketamine-remimazolam DAS, propofol-opioid TIVA, and propofol-opioid DAS.
  • To evaluate the safety and efficacy of different sedation methods during AF ablation.

Main Methods:

  • Patients undergoing AF catheter ablation were randomized into three groups: propofol-opioid DAS (P), remimazolam-ketamine DAS (R), and propofol-opioid TIVA (TIVA).
  • The FARAPULSE system was used for PFA, with obstructive sleep apnea syndrome as a key exclusion criterion.
  • The primary endpoint was a composite of hypoxemia, hypotension, or hypertension requiring intervention; secondary endpoints included hemodynamic events, procedure time, and patient satisfaction.

Main Results:

  • The primary endpoint occurred in 85.7% of patients in the propofol-opioid DAS group (P), 27.9% in the remimazolam-ketamine DAS group (R), and 66.7% in the TIVA group.
  • Hypoxemia was the main driver in the P group (100% of those with endpoint), while hypotension predominated in the TIVA group (100% of those with endpoint).
  • The remimazolam-ketamine DAS group demonstrated a significantly lower incidence of the primary endpoint, with no significant differences in procedural times, serious adverse events, or patient satisfaction.

Conclusions:

  • Ketamine-remimazolam DAS is superior to propofol-opioid regimens for PFA procedures in AF patients.
  • This regimen significantly reduces the risk of hypoxemia and hypotensive events compared to conventional propofol-opioid analgosedation.
  • Over 80% of patients receiving conventional propofol-opioid analgosedation experienced hypoxemia, highlighting the benefits of the remimazolam-ketamine approach.