Sedation Strategies for Defibrillation Threshold Testing: Safety Outcomes with Anesthesiologist Compared to Proceduralist-Directed Sedation. An Analysis from the Shockless Implant Evaluation (SIMPLE) Study

  • Author / Creator
    Quadros, Kenneth
  • Aims: No standard practice exists with respect to anesthesiologist directed sedation (ADS) versus sedation by proceduralist (PDS) for defibrillation threshold (DT) testing. We aimed to evaluate adverse events and safety outcomes with ADS versus PDS for DT testing. Methods: A post-hoc analysis of the Shockless Implant Evaluation (SIMPLE) study was performed among the 1242 patients who had DT testing (624 ADS and 618 PDS). We evaluated both intra-operative and in-hospital adverse composite events and two safety composite outcomes at 30-days of the main trial. Propensity score adjusted models were used to compute odds ratio (OR) and 95% CI to evaluate the association between adverse and safety outcomes with method of sedation and independent predictors for use of ADS.Results: Compared to PDS, patients who received ADS were younger (62±12 years vs. 64±12 years, p=0.01), had lower ejection fraction (LVEF 0.31±13 vs. 0.33±13, p=0.03), were more likely to receive inhalational anesthesia, propofol or narcotics (p<.001, respectively) and receive an arterial line (43% vs.8%, p= <.0001). Independent predictors for ADS sedation were presence of coronary artery disease (OR 1.69, 95% CI 1.0-2.72, p=0.03) and hypertrophic cardiomyopathy (OR 2.64, 95% CI 1.19- 5.85, p=0.02). ADS had higher intra-operative adverse events (2.2% vs 0.5%; OR 4.47, 95% CI 1.25-16.0, p=0.02) and higher primary safety outcomes at 30 days (8.2% vs 4.9%; OR 1.72 95% CI 1.06-2.80, p=0.03) and no difference in other outcomes compared to PDS. Conclusion: Proceduralist directed sedation is safe, however, this could be result of selection bias. Further research is needed.

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  • Graduation date
    Spring 2018
  • Type of Item
  • Degree
    Master of Science
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