We are grateful to Dr Conway for his thoughtful comments1 concerning our recently published study,2 and we are happy to provide the following answers to the issues that he has raised.
First, the relationship between general anaesthesia and complications cannot be easily interpreted in this cohort. General anaesthesia was often performed because of a particular risk of complications, mostly procedural (such as probe extraction), requiring complete immobility and/or at risk of the need for a rescue procedure. The aim of this cohort was to describe the complications rate and risk factors for the overall population admitted to our cardiac electrophysiology laboratory and thus we did not specifically analyse the subgroup of patients undergoing general anaesthetic. Moreover, we are clearly inclined to think that the choice of the anaesthetic procedure is part of the anaesthetic care. To our knowledge, there is no efficient system described in the literature to direct safely ‘low-risk’ patients to nonanaesthetic care and ‘high-risk’ patients to an anaesthetist. Finally, we believe that even the subgroup of deeply sedated patients with its overall complication rate of 26% and severe complication rate of 4% must receive anaesthetic attention.
Second, concerning the remark of Dr Conway that randomised controlled trials are needed, we would argue that it will be difficult to design such a study comparing two systems: anaesthesia care by trained staff (nurse anaesthetist and anaesthesiologist) with a specific training for propofol administration by nurses or cardiologists. In the second one, a failure in the training process or an unusual complication would imply the intervention of an anaesthesiologist or intensivist.
Third, comparing this cohort with other studies seemed difficult because of different definitions of severe complications, study designs and sedation protocols (particularly propofol-associated drugs)2,3 or differences in the procedures requiring sedation.4 Our cohort included only patients requiring cardiovascular implantable electronic devices management and excluded radiofrequency catheter ablation.
Finally, we do agree with Dr Conway that more research on this specific and very fragile population is necessary to eventually improve perioperative care.
Acknowledgements relating to this article
Assistance with the letter: none.
Financial support and sponsorship: none.
Conflicts of interest: none.
1. Conway A. Anaesthesiological support in a cardiac electrophysiology laboratory. Eur J Anaesthesiol
2. Trouvé-Buisson T, Arvieux L, Bedague D, et al. Anaesthesiological support in a cardiac electrophysiology laboratory: a single-centre, prospective observational study. Eur J Anaesthesiol
3. Sayfo S, Vakil KP, Alqaqa’a A, et al. A retrospective analysis of proceduralist-directed, nurse-administered propofol sedation for implantable cardioverter-defibrillator procedures. Heart Rhythm
4. Dupanovic M, Lakkireddy D, Emert MP, Krebill R. Utility of dexmedetomidine in sedation for radiofrequency ablation of atrial fibrillation. J Perianesth Nurs