Abstract：
The authors evaluated the anesthetic approach for cardiovascular implantable electronic device (CIED) placement and transvenous lead removal, hypothesizing that monitored anesthesia care is used more frequently than general anesthesia.
A retrospective study.
National Anesthesia Clinical Outcomes Registry data.
Adult patients who underwent CIED (permanent cardiac pacemaker or implantable cardioverter-defibrillator [ICD]) placement or transvenous lead removal between 2010 and 2021.
None.
Covariates were selected a priori within multivariate models to assess predictors of anesthetic type. A total of 87,530 patients underwent pacemaker placement, 76,140 had ICD placement, 2,568 had pacemaker transvenous lead removal, and 4,861 had ICD transvenous lead extraction; 51.2%, 45.64%, 16.82%, and 45.64% received monitored anesthesia care, respectively. A 2%, 1% (both p < 0.0001), and 2% (p = 0.0003) increase in monitored anesthesia care occurred for each 1-year increase in age for pacemaker placement, ICD placement, and pacemaker transvenous lead removal, respectively. American Society of Anesthesiologists (ASA) physical status ≤III for pacemaker placement, ASA ≥IV for ICD placement, and ASA ≤III for pacemaker transvenous lead removal were 7% (p = 0.0013), 5% (p = 0.0144), and 27% (p = 0.0247) more likely to receive monitored anesthesia care, respectively. Patients treated in the Northeast were more likely to receive monitored anesthesia care than in the West for all groups analyzed (p < 0.0024). Male patients were 24% less likely to receive monitored anesthesia care for pacemaker transvenous lead removal (p = 0.0378). For every additional 10 pacemaker or ICD lead removals performed in a year, a 2% decrease in monitored anesthesia care was evident (p = 0.0271, p < 0.0001, respectively).
General anesthesia still has a strong presence in the anesthetic management of both CIED placement and transvenous lead removal. Anesthetic choice, however, varies with patient demographics, hospital characteristics, and geographic region.
A retrospective study.
National Anesthesia Clinical Outcomes Registry data.
Adult patients who underwent CIED (permanent cardiac pacemaker or implantable cardioverter-defibrillator [ICD]) placement or transvenous lead removal between 2010 and 2021.
None.
Covariates were selected a priori within multivariate models to assess predictors of anesthetic type. A total of 87,530 patients underwent pacemaker placement, 76,140 had ICD placement, 2,568 had pacemaker transvenous lead removal, and 4,861 had ICD transvenous lead extraction; 51.2%, 45.64%, 16.82%, and 45.64% received monitored anesthesia care, respectively. A 2%, 1% (both p < 0.0001), and 2% (p = 0.0003) increase in monitored anesthesia care occurred for each 1-year increase in age for pacemaker placement, ICD placement, and pacemaker transvenous lead removal, respectively. American Society of Anesthesiologists (ASA) physical status ≤III for pacemaker placement, ASA ≥IV for ICD placement, and ASA ≤III for pacemaker transvenous lead removal were 7% (p = 0.0013), 5% (p = 0.0144), and 27% (p = 0.0247) more likely to receive monitored anesthesia care, respectively. Patients treated in the Northeast were more likely to receive monitored anesthesia care than in the West for all groups analyzed (p < 0.0024). Male patients were 24% less likely to receive monitored anesthesia care for pacemaker transvenous lead removal (p = 0.0378). For every additional 10 pacemaker or ICD lead removals performed in a year, a 2% decrease in monitored anesthesia care was evident (p = 0.0271, p < 0.0001, respectively).
General anesthesia still has a strong presence in the anesthetic management of both CIED placement and transvenous lead removal. Anesthetic choice, however, varies with patient demographics, hospital characteristics, and geographic region.
摘要：
目的：作者评估了心血管植入式电子设备（CIED）放置和经静脉引线去除的麻醉方法，假设监测麻醉护理比全身麻醉使用更频繁。
方法：回顾性研究。
方法：国家麻醉临床结果登记数据。
方法：在2010年至2021年之间未接受CIED（永久性心脏起搏器或植入式心脏复律除颤器[ICD]）放置或经静脉导线拔除的成年患者。
方法：无。
结果：在多变量模型中先验选择协变量来评估麻醉类型的预测因子。共有87,530名患者接受了起搏器放置，76,140有ICD放置，2,568例起搏器经静脉导线拔除，4861例ICD经静脉引线拔除；51.2%，45.64%,16.82%,45.64%接受麻醉监护,分别。2%,1%(两者p<0.0001)，和2%（p=0.0003）的监测麻醉护理增加发生每增加1年的年龄起搏器放置，ICD放置,和起搏器经静脉引线去除，分别。美国麻醉医师协会（ASA）起搏器放置的身体状况≤III，用于ICD放置的ASA≥IV，ASA≤III用于起搏器经静脉引线去除的患者为7%（p=0.0013），5%(p=0.0144)，27%(p=0.0247)更有可能接受监测麻醉护理，分别。对于所分析的所有组，在东北接受治疗的患者比在西部接受监测麻醉护理的患者更有可能(p<0.0024)。男性患者接受起搏器经静脉引线去除监测麻醉护理的可能性低24%(p=0.0378)。一年内每移除10个起搏器或ICD导线,监测麻醉护理减少2%(分别为p=0.0271,p<0.0001).
结论：全身麻醉在ED置入和经静脉导线取出的麻醉管理中仍然有很强的存在。麻醉选择,然而,随着患者人口统计学的变化，医院特色,和地理区域。
方法：回顾性研究。
方法：国家麻醉临床结果登记数据。
方法：在2010年至2021年之间未接受CIED（永久性心脏起搏器或植入式心脏复律除颤器[ICD]）放置或经静脉导线拔除的成年患者。
方法：无。
结果：在多变量模型中先验选择协变量来评估麻醉类型的预测因子。共有87,530名患者接受了起搏器放置，76,140有ICD放置，2,568例起搏器经静脉导线拔除，4861例ICD经静脉引线拔除；51.2%，45.64%,16.82%,45.64%接受麻醉监护,分别。2%,1%(两者p<0.0001)，和2%（p=0.0003）的监测麻醉护理增加发生每增加1年的年龄起搏器放置，ICD放置,和起搏器经静脉引线去除，分别。美国麻醉医师协会（ASA）起搏器放置的身体状况≤III，用于ICD放置的ASA≥IV，ASA≤III用于起搏器经静脉引线去除的患者为7%（p=0.0013），5%(p=0.0144)，27%(p=0.0247)更有可能接受监测麻醉护理，分别。对于所分析的所有组，在东北接受治疗的患者比在西部接受监测麻醉护理的患者更有可能(p<0.0024)。男性患者接受起搏器经静脉引线去除监测麻醉护理的可能性低24%(p=0.0378)。一年内每移除10个起搏器或ICD导线,监测麻醉护理减少2%(分别为p=0.0271,p<0.0001).
结论：全身麻醉在ED置入和经静脉导线取出的麻醉管理中仍然有很强的存在。麻醉选择,然而,随着患者人口统计学的变化，医院特色,和地理区域。
