Background
While cardiac catheterisation is typically well tolerated, discomfort and anxiety
are commonplace. Sedation using anxiolytic and analgesic medications has the potential
to ameliorate such symptoms, however, is variably employed, with lack of standardised
regimens and limited evidence.
Methods
We performed a review of the role of sedation for cardiac catheterisation, including
current practices and summarising available evidence relevant to diagnostic and interventional
coronary procedures in the cardiac catheterisation laboratory.
Results
Use of sedation and the medication regimens employed are highly variable. Available
relevant studies are limited in number and mostly small. Sedation appears to modestly
reduce anxiety and pain in most studies. The incidence of radial spasm and the consequent
need to alter access site is reduced with procedural sedation. The majority of existing
evidence applies to benzodiazepines and opioid use, which appear acceptably efficacious
and safe when used with appropriate training and staffing; noting opioid medications
reduce the absorption of loading doses of oral anti-platelet drugs.
Conclusions
In conclusion, benzodiazepines and opioids result a modest reduction in pain, improved
patient tolerability and reduced risk of radial artery spasm. The decision on whether
to use sedation, and which agent(s) and dose, should be individualised based on patient
factors, including need for oral antiplatelet therapy administration. Appropriate
staffing and monitoring is essential.
Keywords
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Article info
Publication history
Published online: September 09, 2019
Accepted:
August 29,
2019
Received in revised form:
May 5,
2019
Received:
December 26,
2017
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
