Cardioversion

Anesthesia Implications

Position: Fowler’s, Semi-Fowler’s, arms free at side
Time: 5-30 min (very short)
Blood Loss: Zero
Post-op Pain: Zero
Maintenance Paralytic: No

Anticoagulated – patient should have remained on his/her anticoagulants for 3-4 weeks prior to this procedure.

Comorbidities – These patients often have multiple comorbidities and can be especially sensitive to propofol – so be very careful with the dosing!

Heparin – Some cardiologists will ask for 5K – 10K units of heparin prior to cardioversion (even if left atrial appendage (LAA) is cleared by the TEE) if the patient missed their dose of anticoagulant or hasn’t had anticoagulation therapy for very long.

TEE – Very common to have an echocardiogram (TEE) done with the cardioversion.

Second attempt – If the A-fib is uncorrected by the first shock, the physician may want to try a second attempt.

From the Pros:

In some cases you’ll encounter patients that are especially at risk for obstruction or hypotension, but require higher doses of propofol. Some have suggested the use of alfentanil as a propofol-sparing adjunct in these patients.

Circulation times are a little slower because of lower EFs & lack of atrial kick. Most important key here is to be patient when you give your drugs. You can always give more – you can’t take it back.

Atrial Flutter – in the case that the patient has atrial flutter, lower joules will be used for the cardioversion