Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stra...Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stratification tool. The purpose of this study is to describe a minimially invasive, effective anesthetic technique to employ during transesophageal electrophysiology studies. Methods: A retrospective review of anesthetic technique utilized during TEEPS. Inclusion criteria;WPW on ECG;age <18 years;and no history of tachycardia, palpitations, or syncope and patient had TEEPS under monitored anesthesia care (MAC). Midazolam, Fentanyl, and Propofol were used in various combinations. Sevoflurane was used during induction period in all GA cases and discontinued 10 minutes prior to initiation of TEEPS. Results: Inclusion criteria were met by 20 patients with an average age of 11.9 years, average weight of 48.9 kg and average height of 149.2 cm. IV sedation was performed on 15%, MAC on 10% and GA in remainder. Airway management techniques included 13.3% LMA, 20% endotrachael tube (ETT) and 66% mask. IV sedation, the initial anesthetic, was found to be cumbersome and uncomfortable. Next was ETT and LMA but trouble pacing was encountered due to positional change of the esophagus relative to the left atrium during ventilation. Mask induction was then performed in remaining 10 patients with TEEPS probe inserted through a nare while anesthesiologist continued mask ventilation. All mask procedures were successful without complications. Conclusions: Induction of anesthesia to perform TEEPS procedures on pediatric patients with Wolff-Parkinson-White syndrome underwent numerous attempts to make the procedure easy, reliable and reproducible for anesthesia and electrophysiologist. The eventual technique that proved to meet these criteria during a transesopheagel electrophysiology procedure was utilization of mask induction with continuous IV sedation.展开更多
目的：探讨无创性经食管信号叠加直接记录窦房结电位(SNP)的技术。方法：对8只犬进行了系统实验研究，并对256例食管电生理检查窦房结传导时间(SACT)和窦房结恢复时间(SNRT)均在正常范围的患者，其中男142例、女114例，年龄10～74(44.2&...目的：探讨无创性经食管信号叠加直接记录窦房结电位(SNP)的技术。方法：对8只犬进行了系统实验研究，并对256例食管电生理检查窦房结传导时间(SACT)和窦房结恢复时间(SNRT)均在正常范围的患者，其中男142例、女114例，年龄10～74(44.2±12.4)岁进行检测。采用自制三导心电微电位检测仪将食管导联的信号放大(增益达到100_μV/cm)、滤波(0.1～50Hz)，16位模/数(A/D)转换，系统采样频率2kHz，对信号进行叠加，189例(74%)记录到食管 SNP。结果：所测信号叠加食管 SNP 为 P 波前的低幅、低频波，可见有两种形态：园顶型(60%)和上斜型(40%)。所测窦房传导时间为(83.3±26.7)ms，分布范围为(23～118)rm；波幅为3.5～27.7μV；dv/dt为0.43～1.93mV/s。结论：我们认为在适当的滤波、高增益和抗基线漂移技术条件下，利用经食管信号叠加技术，大多数窦房结功能正常的患者可直接记录到食管 SNP。展开更多
文摘Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stratification tool. The purpose of this study is to describe a minimially invasive, effective anesthetic technique to employ during transesophageal electrophysiology studies. Methods: A retrospective review of anesthetic technique utilized during TEEPS. Inclusion criteria;WPW on ECG;age <18 years;and no history of tachycardia, palpitations, or syncope and patient had TEEPS under monitored anesthesia care (MAC). Midazolam, Fentanyl, and Propofol were used in various combinations. Sevoflurane was used during induction period in all GA cases and discontinued 10 minutes prior to initiation of TEEPS. Results: Inclusion criteria were met by 20 patients with an average age of 11.9 years, average weight of 48.9 kg and average height of 149.2 cm. IV sedation was performed on 15%, MAC on 10% and GA in remainder. Airway management techniques included 13.3% LMA, 20% endotrachael tube (ETT) and 66% mask. IV sedation, the initial anesthetic, was found to be cumbersome and uncomfortable. Next was ETT and LMA but trouble pacing was encountered due to positional change of the esophagus relative to the left atrium during ventilation. Mask induction was then performed in remaining 10 patients with TEEPS probe inserted through a nare while anesthesiologist continued mask ventilation. All mask procedures were successful without complications. Conclusions: Induction of anesthesia to perform TEEPS procedures on pediatric patients with Wolff-Parkinson-White syndrome underwent numerous attempts to make the procedure easy, reliable and reproducible for anesthesia and electrophysiologist. The eventual technique that proved to meet these criteria during a transesopheagel electrophysiology procedure was utilization of mask induction with continuous IV sedation.
文摘目的：探讨无创性经食管信号叠加直接记录窦房结电位(SNP)的技术。方法：对8只犬进行了系统实验研究，并对256例食管电生理检查窦房结传导时间(SACT)和窦房结恢复时间(SNRT)均在正常范围的患者，其中男142例、女114例，年龄10～74(44.2±12.4)岁进行检测。采用自制三导心电微电位检测仪将食管导联的信号放大(增益达到100_μV/cm)、滤波(0.1～50Hz)，16位模/数(A/D)转换，系统采样频率2kHz，对信号进行叠加，189例(74%)记录到食管 SNP。结果：所测信号叠加食管 SNP 为 P 波前的低幅、低频波，可见有两种形态：园顶型(60%)和上斜型(40%)。所测窦房传导时间为(83.3±26.7)ms，分布范围为(23～118)rm；波幅为3.5～27.7μV；dv/dt为0.43～1.93mV/s。结论：我们认为在适当的滤波、高增益和抗基线漂移技术条件下，利用经食管信号叠加技术，大多数窦房结功能正常的患者可直接记录到食管 SNP。
