Tachyarrhythmia Clinical Trial
Official title:
A Pilot Study to Investigate the Efficacy and Safety of Dexmedetomidine and Fentanyl Versus Midazolam and Remifentanil for Sedation in Patients Undergoing Ablation Procedures for Treatment of a Tachyarrhythmia
To evaluate the safety and efficacy of dexmedetomidine and compare this to a current
technique commonly used at TGH for sedation in patients undergoing ablation procedures for
atrial fibrillation (AF) and atrial flutter.
The investigators hypothesise that dexmedetomidine will be at least equivalent to, or more
so, in terms of effectiveness and safety, when compared to midazolam and remifentanil for
sedation during ablation procedures.
The role of ablation for chronic persistent AF has been debated amongst cardiologists for
some time, and there is increasing evidence that ablation may be superior to medical
management. As populations age, the rate of AF is likely to increase and therefore the
numbers of ablations performed for this arrhythmia will also be expected to increase.
Ablation procedures can vary in length from one to more than 6 hours in duration and require
the patient to keep still so as not to influence the mapping procedure.
Options for anaesthesia care include a general anaesthetic or sedation. Several studies have
evaluated the safety of sedation for ablation, using combinations of fentanyl, midazolam and
propofol. These demonstrate that the ablation procedures are well tolerated under deep
sedation.
Dexmedetomidine is an attractive potential agent for this role due to its favourable
respiratory pharmacodynamics and good sedation profile. Dexmedetomidine is a short acting
relatively specific alpha-2 receptor agonist (alpha 2: alpha 1 = 1300:1). It has been shown
to have very little effect on respiratory parameters, even at high doses.In addition, it may
offer some analgesic properties and therefore minimise the need for narcotic based agents.
the investigators will compare dexmedetomidine infusion and fentanyl bolus with remifentanil
infusion midazolam bolus.
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