A quantitative study on the use of propofol for patient comfort during pacemaker implantation. Brenda J. Wagner, RN
April 27, 2010
A quantitative study on the use of propofol for patient comfort during pacemaker implantation. Problem Section
In today’s healthcare environment, more procedures are taking place with conscious sedation utilized instead of general anesthesia. According to Somerson, Husted, and Sicilia (1995), conscious sedation is defined as “a minimally depressed level of consciousness during which the patient retains his ability to maintain a continuously patent airway and respond appropriately to physical stimulation or verbal commands”. This is beneficial for several reasons. When using conscious sedation, a patient is able to maintain their own airway, meaning that an invasive airway such as intubation is not necessary, thereby reducing potential complications from intubation. Also, patients who are high risk for airway complications with intubation due to a history of respiratory problems can now undergo procedures using conscious sedation instead. Conscious sedation also provides reduced recovery times in comparison to general anesthesia, reducing the length of stay needed after procedures.
Conscious sedation also provides for patient comfort during procedures which is important in nursing care. Conscious sedation is aimed at keeping a patient comfortable throughout a procedure but does present challenges for nursing care. In the electrophysiology department, this is especially important since procedures require a patient to remain still throughout the case while an electrophysiologist is implanting leads into the patient’s heart muscle. Because of this, conscious sedation becomes a vital concern for nursing. In the electrophysiology department at Summa Akron City Hospital, conscious sedation for an implantable permanent pacemaker device is usually administered by a registered nurse trained in administration of conscious sedation. The medications that are typically used for this are midazolam and fentanyl. In contrast, during implantable cardio defibrillator insertion, typically a certified registered nurse anesthetist administers the sedation with the use of propofol, midazolam and fentanyl. Since propofol is listed as an anesthetic agent, according to the Ohio Board of Nursing, it must be administered by anesthesia personnel (OBN, 2005).
When talking with patients prior to having a device implanted, many will state that they just want to be put to sleep during their procedure so they do not remember anything. Patient anxiety prior to any type of surgery is to be expected, especially when they are having a procedure for the first time. They may be concerned with noises they hear during the procedure, apprehensive about feeling pain from the local anesthetic or from the initial incision, or even about feeling vulnerable while laying on a small table with their hands secured.
It is unknown whether patients are more comfortable during pacemaker implantation when propofol is used in conjunction with midazolam and fentanyl, or if midazolam and fentanyl alone are adequate to ensure patient comfort. The purpose of this study would be to compare the comfort level of patients during pacemaker implantation using midazolam and fentanyl or using midazolam, fentanyl and propofol. Literature Review
The issue of conscious surgery in patients has been researched in relation to gastroenterology procedures (Lee & Kim, 2009), dental procedures (Oei-Lim, Kalkman, Makkes, & Ooms, 1998) and within the last fifteen years in use in the electrophysiology lab (Geiger, Wase, Kearney, Brandon, Kent, Newby, & Natale, 1997). Implantations of pacemakers and cardioverter defibrillators were once performed in the operating rooms under general anesthesia, however that changed to anesthesia supervised implantation (Geiger, et al, 1997). The...