I have been asked several times for my position for or against general anesthesia during ablation treatment. The issue has been furiously debated on social media. I can also see that several hospitals advocate for the use of general anesthesia as a “quality factor”.
To find an answer let’s break down the reasons for using anesthesia during ablation treatment.
Why give anesthesia or sedatives during ablation treatment?
The reasons for giving anesthesia or sedatives in connection with ablation treatment are:
- to alleviate anxiety
- to alleviate pain
- to make it easier to accept the time the procedure takes – and lie still
In principle, the problem is approached in different ways:
- General anesthesia: This means that you are completely unconscious and require help with breathing. Often a tube is inserted into the trachea or by means of a so-called “laryngeal mask”, which is located in the larynx and is connected to a respirator or a ventilation bag.
- Local anesthesia: combined with medications with sedatives and painkillers directly into the bloodstream through a catheter (“Venflon”).
- Local anesthesia and constant medication with sedatives and painkillers: Here physicians typically use the same types of medication as with a general anesthetic. But in slightly smaller quantities, so that you can breathe yourself. This is called “deep sedation”.
What is my recommendation?
I myself prefer to use the third solution- that is, local anesthesia combined with constant medication with sedatives and painkillers. I use medications called propofol (anesthetic) and ultiva (painkillers). The advantages of this approach are – in my opinion – that you add less sedatives and painkillers. This reduces the discomfort after anesthesia such as nausea, malaise and vomiting.
However the most important aspect is that it allows me to have contact with my patient during the entire procedure. I personally believe that it reduces the risks of some rare – but very serious – complications to the ablation procedure, especially ablation for atrial fibrillation. This is not substantiated by major scientific studies, but is based on my own experience (more than 8,000 ablations) and on conversations with colleagues around the world who have experienced these rare complications.
By giving both the sedative and the painkiller constantly, it becomes possible – with experience – to set the medication exactly so that you have the desired painkiller effect at the time you need it. Namely when you are going to start the actual procedure. In addition, I am very aware that there is complete calm in the operating room. So speech and sounds in general are limited to an absolute minimum. This approach – which I have been practicing for more than 15 years – offers, in my opinion, the same benefits as applying general anesthesia. But without the disadvantages that can be associated with this.
With that said, I am also of the opinion that general anesthesia can be okay to use if you – as a patient – are particularly anxious about the operation.
In contrast, it is my experience that the method of combining local anesthesia and repeated doses of relaxing and analgesic medication is not optimal. Often, as a physician, you will not wait long enough for the medicine to take full effect. This can mean that pain occurs – and then even higher doses are needed to have a satisfactory effect.
I would note that general anesthesia may, in my experience, be inappropriate in those situations where there is no treatment of atrial fibrillation or atrial flutter. Here one would often like to try to provoke the relevant heart rhythm disorder. And this can be made more difficult if you use general anesthesia.
There are several approaches
Although I myself prefer to have a routine of combined local anesthesia and constant medication with relaxing and painkillers, it may be perfectly okay to approach it in other of the ways mentioned. Including applying general anesthesia. The most important thing is probably to have some well-proven routines and a good collaboration with the doctors who are usually responsible for anesthetizing patients (anesthesiologists).