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Revista Brasileira de Anestesiologia
On-line version ISSN 1806-907X
NORA, Fernando Squeff; PIMENTEL, Maurício; ZIMERMAN, Leandro Ioschpe and SAAD, Eduardo B. Total intravenous anesthesia with target-controlled infusion of remifetanil and propofol for ablation of atrial fibrillation. Rev. Bras. Anestesiol. [online]. 2009, vol.59, n.6, pp.735-740. ISSN 1806-907X. http://dx.doi.org/10.1590/S0034-70942009000600009.
BACKGROUND AND OBJECTIVES: Although ablation of atrial fibrillation (AF) is common in other centers, among us it is a new procedure. The choice of anesthesia, monitors, and anesthesiologic care for this procedure performed outside the surgical center has not been described. The objective of this report was to describe an anesthesia technique for ablation of AF. CASE REPORT: This is a 49-year old female weighing 73 kg, 155 cm, and ASA II due to hypertension. The patient was monitored with a 12-lead ECG, pulse oximetry, heart rate, bispectral electroencephalography for BIS measurement, suppression rate (SR), and SEF95, and mean arterial pressure (MAP). Intravenous target-controlled infusion (TCI) of propofol with a target of 4 µg.mL-1, intravenous TCI of remifentanil with a target of 3 ng.mL-1, and intravenous bolus of rocuronium 0.2 mg.kg-1 were used for induction of anesthesia. The pharmacokinetic model of propofol described by Marsh was used and incorporated into the propofol PFS pump®. The pharmacokinetic model of remifentanil described by Minto was incorporated into the Alaris PK® infusion pump. Local effector, or biophase, concentrations corresponded to the information obtained from the infusion pumps and represented predictive measurements of the concentrations of both drugs on their sites of action. The concentrations of propofol and remifentanil were regulated according to BIS and MAP, respectively. CONCLUSIONS: Total intravenous anesthesia for ablation of AF can be a safe option considering the lack of electrophysiological changes in accessory pathways. The literature on this subject is scarce and new publications could justify, or not, this type of anesthesia during ablation of AF.
Keywords : ANESTHESIA, General [intravenous]; DIAGNOSTIC AND TREATMENT PROCEDURES [ablation of atrial fibrillation]; EQUIPMENT, Infusion pump [target-controlled].