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Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation

BACKGROUND: The present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation. METHODS: In t...

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Autores principales: Takigawa, Masateru, Takahashi, Atsushi, Kuwahara, Taishi, Okubo, Kenji, Nakashima, Emiko, Watari, Yuji, Yamao, Kazuya, Nakajima, Jun, Tanaka, Yasuaki, Takagi, Katsumasa, Kimura, Shigeki, Hikita, Hiroyuki, Hirao, Kenzo, Isobe, Mitsuaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529327/
https://www.ncbi.nlm.nih.gov/pubmed/28765755
http://dx.doi.org/10.1016/j.joa.2017.01.003
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author Takigawa, Masateru
Takahashi, Atsushi
Kuwahara, Taishi
Okubo, Kenji
Nakashima, Emiko
Watari, Yuji
Yamao, Kazuya
Nakajima, Jun
Tanaka, Yasuaki
Takagi, Katsumasa
Kimura, Shigeki
Hikita, Hiroyuki
Hirao, Kenzo
Isobe, Mitsuaki
author_facet Takigawa, Masateru
Takahashi, Atsushi
Kuwahara, Taishi
Okubo, Kenji
Nakashima, Emiko
Watari, Yuji
Yamao, Kazuya
Nakajima, Jun
Tanaka, Yasuaki
Takagi, Katsumasa
Kimura, Shigeki
Hikita, Hiroyuki
Hirao, Kenzo
Isobe, Mitsuaki
author_sort Takigawa, Masateru
collection PubMed
description BACKGROUND: The present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation. METHODS: In total, 246 consecutive patients with AF (mean age, 65±10 years; 60 women) underwent CA under dexmedetomidine-based continuous deep sedation. A 4-mm pediatric intubation tube guided by a 10-French intratracheal suction tube was inserted smoothly, and the tip of the tube was located at the base of the epiglottis. The maximum shifting distance of the heart (MSDH) was measured with the 3D mapping system (Ensite NavX system) before and after inserting the pediatric intubation tube. RESULTS: At baseline, the MSDH of patients under continuous deep sedation was 23±14 mm. The pediatric intubation tube reduced the MSDH to 13±6 mm (mean reduction from baseline, 38.4±21.7%; P<0.0001). In contrast, oxygen saturation was significantly increased from 89±8% to 95±3% (P<0.0001). The mean distance between the nostril and base of the epiglottis was 16.6±0.5 mm. Major periprocedural complications occurred in 9 (3.6%) patients including 3 (1.2%) cardiac tamponade and 6 (2.4%) phrenic nerve injury cases. Larger MSDH (odds ratio, 1.13; 95% confidence interval, 1.04–1.25; P=0.007) was a significant predictor of major periprocedural complications. No major airway complications occurred, except in 3 patients (1.2%) who had minor nasal bleeding. CONCLUSION: This unique airway management technique using a pediatric intubation tube for CA procedures performed in adult patients with AF under continuous deep sedation was easy, safe, and effective.
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spelling pubmed-55293272017-08-01 Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation Takigawa, Masateru Takahashi, Atsushi Kuwahara, Taishi Okubo, Kenji Nakashima, Emiko Watari, Yuji Yamao, Kazuya Nakajima, Jun Tanaka, Yasuaki Takagi, Katsumasa Kimura, Shigeki Hikita, Hiroyuki Hirao, Kenzo Isobe, Mitsuaki J Arrhythm Original Article BACKGROUND: The present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation. METHODS: In total, 246 consecutive patients with AF (mean age, 65±10 years; 60 women) underwent CA under dexmedetomidine-based continuous deep sedation. A 4-mm pediatric intubation tube guided by a 10-French intratracheal suction tube was inserted smoothly, and the tip of the tube was located at the base of the epiglottis. The maximum shifting distance of the heart (MSDH) was measured with the 3D mapping system (Ensite NavX system) before and after inserting the pediatric intubation tube. RESULTS: At baseline, the MSDH of patients under continuous deep sedation was 23±14 mm. The pediatric intubation tube reduced the MSDH to 13±6 mm (mean reduction from baseline, 38.4±21.7%; P<0.0001). In contrast, oxygen saturation was significantly increased from 89±8% to 95±3% (P<0.0001). The mean distance between the nostril and base of the epiglottis was 16.6±0.5 mm. Major periprocedural complications occurred in 9 (3.6%) patients including 3 (1.2%) cardiac tamponade and 6 (2.4%) phrenic nerve injury cases. Larger MSDH (odds ratio, 1.13; 95% confidence interval, 1.04–1.25; P=0.007) was a significant predictor of major periprocedural complications. No major airway complications occurred, except in 3 patients (1.2%) who had minor nasal bleeding. CONCLUSION: This unique airway management technique using a pediatric intubation tube for CA procedures performed in adult patients with AF under continuous deep sedation was easy, safe, and effective. Elsevier 2017-08 2017-02-21 /pmc/articles/PMC5529327/ /pubmed/28765755 http://dx.doi.org/10.1016/j.joa.2017.01.003 Text en © 2017 Japanese Heart Rhythm Society. Published by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Takigawa, Masateru
Takahashi, Atsushi
Kuwahara, Taishi
Okubo, Kenji
Nakashima, Emiko
Watari, Yuji
Yamao, Kazuya
Nakajima, Jun
Tanaka, Yasuaki
Takagi, Katsumasa
Kimura, Shigeki
Hikita, Hiroyuki
Hirao, Kenzo
Isobe, Mitsuaki
Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation
title Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation
title_full Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation
title_fullStr Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation
title_full_unstemmed Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation
title_short Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation
title_sort airway support using a pediatric intubation tube in adult patients with atrial fibrillation: a simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5529327/
https://www.ncbi.nlm.nih.gov/pubmed/28765755
http://dx.doi.org/10.1016/j.joa.2017.01.003
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