From the Guidelines
You are typically under conscious sedation during a cardiac catheterization, rather than general anesthesia, as it carries fewer risks while providing adequate comfort. The decision to use conscious sedation or general anesthesia depends on various factors, including the patient's age, medical condition, and the complexity of the procedure. According to the most recent and highest quality study, 1, conscious sedation is associated with fewer requirements for inotropes/vasopressors, shorter lengths of hospital stay, and shorter procedural/intervention times, with earlier patient mobilization.
The advantages of conscious sedation include:
- Fewer risks compared to general anesthesia
- Prompt detection of adverse neurological events
- Earlier patient mobilization
- Shorter procedural/intervention times
However, general anesthesia may be necessary in certain cases, such as:
- Patients requiring transesophageal echocardiography (TEE) guidance during valve deployment
- Patients with borderline vascular access, cognitive or language barriers, or an inability to stay still or lie flat
- Patients with chronic pain, morbid obesity, or other issues that may require more intensive anesthesia care
The anesthesia team will administer medications, such as midazolam (Versed) and fentanyl, through an IV, adjusting the dosage as needed throughout the procedure to ensure the patient's comfort and safety. As noted in 1, the complication rates for cardiac catheterization in children with pulmonary hypertension are low, ranging from 0% to 1%, when performed by experienced teams. Similarly, in adults, the use of conscious sedation for cardiac catheterization and other procedures, such as transcatheter aortic valve replacement, has been shown to be safe and effective, with fewer complications and shorter recovery times compared to general anesthesia 1.
From the FDA Drug Label
Midazolam Injection is indicated: ... intravenously as an agent for sedation/anxiolysis/amnesia prior to or during diagnostic, therapeutic or endoscopic procedures, such as ... cardiac catheterization...
- Yes, you may be under anesthesia, specifically sedation/anxiolysis/amnesia, for cardiac catheterization using midazolam (IV) 2.
From the Research
Sedation for Cardiac Catheterization
- Patients undergoing cardiac catheterization may receive sedation to reduce anxiety and pain, but the type and dosage of sedation can vary depending on the patient and the procedure 3.
- Sedation can be categorized into minimal, moderate, or deep sedation, and the choice of sedation depends on patient factors such as age, cardiovascular stability, and pain tolerance, as well as procedural factors such as complexity and extent of induced pain 4.
- Benzodiazepines and opioids are commonly used for sedation during cardiac catheterization, and have been shown to be effective in reducing anxiety and pain, although their use can be associated with risks such as respiratory depression and radial artery spasm 3.
Types of Sedation
- Conscious sedation, which allows the patient to remain awake and responsive, is often used for cardiac catheterization procedures 5, 6.
- Music therapy has been shown to be an effective adjunct to pharmacological sedation, and can reduce anxiety and pain perception in patients undergoing cardiac catheterization 5.
- Remimazolam, a benzodiazepine with a short half-life, has been shown to be effective for procedural sedation during cardiac catheterization, with minimal adverse effects 6.
Administration of Sedation
- Sedation can be administered by a nurse or an anesthesiologist, depending on the patient's needs and the complexity of the procedure 7.
- Guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterization laboratory have been developed, and emphasize the importance of pre-procedural assessment, patient education, and intra-procedural monitoring 7.
- The decision to use sedation, and the choice of sedation agent and dosage, should be individualized based on patient factors and procedural considerations 3.