Investigating Deep Sedation With Intravenous Ketamine in Spontaneous Respiration During Pulsed-Field Ablation

• Published in: Journal of cardiothoracic and vascular anesthesia 2024-01, Vol.38 (1), p.148-154
• Main Authors: Iacopino, Saverio, Filannino, Pasquale, Artale, Paolo, Petretta, Andrea, Colella, Jacopo, Statuto, Giovanni, Di Vilio, Alessandro, Dini, Daniele, Mantovani, Lorenzo, Rago, Antonio, Sorrenti, Paolo Francesco, Fabiano, Gennaro, Campagna, Giuseppe, Fabiano, Emmanuel, Malacrida, Maurizio, Cecchini, Federico
• Format: Article
• Language: English
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2023.10.024

The authors report their experience of a protocol for deep sedation with ketamine in spontaneous respiration during the pulsed-field ablation (PFA) of atrial fibrillation (AF). Observational, prospective, nonrandomized fashion. Single-center hospitalized patients. All consecutive patients undergoing PFA of AF. Patients undergoing deep sedation with intravenous ketamine. The authors' sedation protocol involves the intravenous administration of fentanyl (1.5 µg/kg) and midazolam (2 mg) at low doses before local anesthesia with lidocaine. A ketamine adjunct (1 mg/kg) in 5-minute boluses was injected about 5 minutes before the first PFA delivery. The authors enrolled 117 patients (age = 59 ± 10 y, 74.4% males, body mass index = 27.6 ± 5 kg/m , fluoroscopy time = 24 ± 14 minutes, skin-to-skin time = 80 ± 40 minutes and PFA LA dwell time = 24 ± 7 minutes). By the end of the procedure, pulmonary vein isolation had been achieved in all patients using PFA alone. The mean time under sedation was 54.9 ± 6 minutes, with 92 patients (79%) being sedated for