A Survey of Current Anesthesia Trends for Electrophysiology Procedures

Eric W. Nelson, DO; Erick M. Woltz, BS; Bethany J. Wolf, PhD; Michael R. Gold, MD, PhD

Disclosures

Anesth Analg. 2018;127(1):46-53. 

In This Article

Abstract and Introduction

Abstract

Background: There has been a dramatic shift in recent years in anesthesia coverage for electrophysiology (EP) procedures. An anesthesiologist and electrophysiologist at our institution jointly developed a survey, which was distributed to the Society of Cardiovascular Anesthesiologists and the Heart Rhythm Society. Its goal was to document current practice patterns and examine perceived variability in coverage.

Methods: On approval of the leadership from the Society of Cardiovascular Anesthesiologists and the Heart Rhythm Society, an online survey was administered to the membership. The survey included demographic data, anesthetic type, and perceptions of the respondents.

Results: Four hundred seventy-nine surveys were completed. Thirty-eight percent were completed by electrophysiologists and 63% by anesthesiologists, giving a response rate of 8.24% for anesthesiologists and 13.6% for electrophysiologists. Of these, 57% of respondents worked in an academic setting. Over the past 2 years, 66.5% of respondents reported anesthesia involvement in EP cases increasing. These cases are reportedly covered by all anesthesiologists in a group 55% of the time, cardiac anesthesia 32.5%, and a designated team at the remainder of the institutions. Seventy-six percent of respondents reported having designated EP block time in the schedule. Ninety-two percent of respondents reported that patient satisfaction has increased with the involvement of anesthesia services.

Conclusions: Anesthesia coverage for EP procedures has continued to increase with an increase in patient satisfaction. Anesthesiologists have had to adapt and provide designated block time to accommodate this increase and also, in some instances, form teams that go beyond simply cardiac anesthesiologists to care for these patients during their procedures.

Introduction

The role of anesthesiology in cardiac surgical operations is well established. Anesthesia is also frequently required for many cardiac procedures performed by cardiologists. The level of such anesthesia can range from conscious sedation to general anesthesia. The area with likely the greatest need for anesthesia among cardiology specialties is in electrophysiology (EP), as some procedures such as cardioversion or defibrillation testing require deep sedation for pain control, while others such as complex ablation may require general anesthesia given the duration of study and need to minimize patient movement.[1–4] Given the growth and complexity of EP procedures[5] over the past decade as well as adoption of newer anesthesia regulations and policies, such as nonanesthesiologists no longer being able to provide deep sedation at some institutions, there has been a significant shift in recent years in anesthesia coverage for EP procedures.[6] However, little quantification of these changes is available.[7] Accordingly, a large US-based survey was undertaken to provide insight with regard to such activities. Both anesthesiologists and electrophysiologists were included, and the present study focuses on a comparison of the perceptions of the 2 specialties.

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