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- Title
Srovnání farmakologických protokolů s použitím fentanylu a nalbufinu v intravenózní analgosedaci u pacientů podstupujících radiofrekvenční katetrovou ablaci fibrilace síní.
- Authors
Šafaříková, Iva; Bulava, Alan; Váchová, Pavla; Růžičková, Veronika; Klimešová, Miroslava; Pražáková, Anna; Stráská, Šárka; Kukrálová, Hana; Sitek, David; Haniš, Jiří
- Abstract
Introduction: Radiofrequency (RF) ablation of atrial fibrillation (AF) is the most common electrophysiological procedure at present time. RF ablation of AF requires longer procedure times and a relatively high amount of RF energy delivered, which may cause significant pain to patients. Therefore, it is mandatory to maintain an adequate level of analgosedation to minimize pain for a successful accomplishment of the procedure. Goal: To compare the subjective efficacy of two pharmacologic protocols (paracetamol-nalbuphine vs. diazepam-fentanyl) using equianalgesic doses of fentanyl and nalbuphine as an IV analgesic regimen in patients undergoing RF ablation of AF, and to establish their safety as well as to assess the level of proceduralist satisfaction with analgesic effects of these drugs. Methods and Results: One hundred consecutive patients were randomized in a 1:1 ratio to a group which received diazepam 5 mg IV + fentanyl during ablation (FEN group, mean age 66.7 ± 8.1 years), and to a group receiving paracetamol 1,000 mg IV + nalbuphine (NAL group, mean age 64.6 ± 8.2 years). The mean doses of fentanyl and nalbuphine were 0.19 ± 0.06 mg and 22.7 ± 5.8 mg, respectively. The mean procedure time was 100 ± 22 mins and 102 ± 26 mins in the FEN and NAL groups, respectively (p = 0.78). The number of RF energy applications and RF energy application times were comparable between the groups (67 ± 23 vs. 64 ± 22, p = 0.46, and 1571 ± 552 s vs. 1775 ± 2036 s, p = 0.5, respectively). The mean pain scores in the FEN and NAL groups on the visual analogue scale (VAS) were 5.4 ± 2.5 and 5.1 ± 2.2, respectively (p = 0,59). Analgesic effect as assessed by the proceduralist using the modified Likert scale (1 to 5) was also similar between the groups (1.7 ± 0.7 in FEN vs. 1.8 ± 0.8 in NAL, p = 0.92). Adverse effects of fentanyl were hypotension (4% of patients) and respiratory depression (2% of patients), while the most common side effect of nalbuphine was excessive sweating (66% of patients). Conclusion: Use of the opioid analgesics fentanyl and nalbuphine appears to be a safe and effective method of analgosedation during RF ablations of AF for both the patients and the proceduralists. The administration of paracetamol and nalbuphine was associated with a significant occurrence of excessive sweating. However, more severe complications, such as severe hypotension and respiratory depression, may rarely be expected when using the combination of benzodiazepine and fentanyl as part of the analgosedation regimen.
- Publication
Intervencní a Akutní Kardiologie, 2021, Vol 20, Issue 3, p165
- ISSN
1213-807X
- Publication type
Article