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Minerva Cardioangiologica 2020 Sep 29

DOI: 10.23736/S0026-4725.20.05211-1


language: English

Procedural sedation and analgesia for percutaneous high tech cardiac procedures

Alberto ZANGRILLO 1, 2, Federica MORSELLI 1, Gaetano LOMBARDI 1, Andrey YAVOROVSKIY 3, Valery LIKHVANTSEV 4, Luigi BERETTA 1, 2, Fabrizio MONACO 1, Giovanni LANDONI 1, 2

1 IRCCS San Raffaele Scientific Institute, Milan, Italy; 2 Vita-Salute San Raffaele University, Milan, Italy; 3 Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia; 4 V. Negovsky Reanimatology Research Institute, Moscow, Russia


The interest in percutaneous high tech cardiac procedures has increased in recent years together with its safety and efficacy. In fragile patients, procedural sedation and analgesia are used to perform most of the procedures. General anesthesia remains the technique of choice during the team learning curve and might be required in selected patients or in emergent situations. Despite the high costs of percutaneous high tech cardiac procedures, the decrease in length of hospital stay, rate of intensive care admission and complications, balance the increase in devices costs. In fragile patients who undergo percutaneous high tech cardiac procedures, the primary role of the anesthesiologist is to prevent the need forpostprocedural intensive care unit and complications rate. Starting from the experience of a large university third level hospital we identified the eight most commonly performed contemporary percutaneous high tech cardiac procedures (ventricular tachycardia and atrial fibrillation ablation, protected percutaneous coronary intervention, transcatheter aortic valve implantation, MitraClip®, percutaneous patent foramen ovale closure, left atrial appendage closure, and dysfunctional lead extraction), discuss the role of procedural sedation and analgesia in this setting, and explore future perspectives.

KEY WORDS: Sedation; Anesthesia; Intensive Care; High tech procedures; Percutaneous cardiac procedures; Cardiac surgery; Procedural sedation and analgesia

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