Ultrasound-guided serratus anterior plane block combined with the two-incision technique for subcutaneous ICD implantation

2018 ◽  
Vol 41 (5) ◽  
pp. 517-523 ◽  
Author(s):  
Andrea Droghetti ◽  
Erika Basso Ricci ◽  
Paolo Scimia ◽  
Fabiola Harizai ◽  
Massimiliano Marini
Keyword(s):  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Icd Implantation ◽  
Subcutaneous Icd ◽  
Incision Technique ◽  
Anterior Plane

Ultrasound‐guided serratus anterior plane block and parasternal block in cooperative sedation for S‐ICD implantation

2019 ◽  
Vol 42 (7) ◽  
pp. 1076-1078 ◽  
Author(s):  
Andrea Droghetti ◽  
Pierfrancesco Fusco ◽  
Massimiliano Marini ◽  
Fabiola Harizai ◽  
Paolo Scimia
Keyword(s):  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Icd Implantation ◽  
Anterior Plane

Intermuscular S-ICD Implantation in Pediatric Patients

2019 ◽  
Vol 68 (01) ◽  
pp. 068-071 ◽  
Author(s):  
Andrea Ferreiro-Marzal ◽  
Fernando Rodríguez-Serrano ◽  
María Esteban-Molina ◽  
Teresa González-Vargas ◽  
Francesca Perin ◽  
...  
Keyword(s):  
Cardiac Death ◽  
Pediatric Patients ◽  
Implantable Cardioverter Defibrillators ◽  
Serratus Anterior ◽  
Cardiorespiratory Arrest ◽  
Icd Implantation ◽  
Subcutaneous Icd ◽  
Anterior Latissimus Dorsi ◽  
Incision Technique ◽  
Cardioverter Defibrillators

AbstractThe use of conventional implantable cardioverter-defibrillators (ICDs) in children presents important technical challenges. We present the surgical technique necessary to adapt the subcutaneous ICD (S-ICD) implantation designed for adults, to children, including patients weighing less than 20 kg. The implant procedure implies a two-incision technique and interfascial serratus anterior–latissimus dorsi dissection to accommodate the device. S-ICD implantation was successfully performed in three patients of 19, 28, and 24 kg, respectively, two of them suffered cardiorespiratory arrest. Intermuscular thoracic implantation of S-ICD might represent an effective strategy for primary or secondary prevention of sudden cardiac death in pediatric patients.

P527Ultrasound-guided serratus anterior plane block for S-ICD implantation using the intermuscular technique

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Migliore ◽  
P De Franceschi ◽  
M De Lazzari ◽  
C Miceli ◽  
C Crescenzi ◽  
...  
Keyword(s):  
Anesthetic Management ◽  
Pharmacological Interventions ◽  
Hemodynamic Changes ◽  
Serratus Anterior ◽  
Icd Implantation ◽  
Study Population ◽  
Incision Technique ◽  
Anterior Plane ◽  
Average Procedure Time ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements NONE Background operative anesthetic requirements and peri-operative discomfort are barriers to wide adoption of the subcutaneous implantable cardioverter defibrillator (S-ICD) system expecially when the intermuscular technique is used due to the greater amount of tissue dissection. The procedure is most commonly performed under general anesthesia (GA). There is growing interest in transitioning away from the routine use of GA and towards several alternative anesthesia modalities implifying the anesthetic management of the S-ICD implant procedure without the involvement of an anesthesiologist. Purpose we assessed the feasibility of ultrasound-guided serratus anterior plane block (US-SAPB) in patients undergoing S-ICD implantation with the intermuscular two-incision technique. Methods: the study population included 38 consecutive patients (84% male; median, 53 [46-62] years) who received S-ICD implantation using the intermuscular two-incision technique. All procedures were performed under US-SAPB and sedoanalagesia without the involvement of an anesthesiologist. Results the average procedure time was 67 ± 14 minutes.No patient experienced significant hemodynamic changes or oxygen desaturation during the period of US- SAPB procedure and sedation; there was no need for pharmacological interventions. The whole procedute was well tollerated without discomfort and complications in the absence of needing GA except in one (2.6%) patient who required GA with laryngeal mask airway. Patients remained always able to respond appropriately to neurological monitoring during S-ICD implantation procedure. There were no procedure-related complications. Conclusion US-SAPB and the intermuscular two-incision technique may be a safe and feasible promising combination for S-ICD implantation overcoming potential barrier to wieder S-ICD adoption in the clinical practice.

scholarly journals Serratus anterior plane block reduces perioperative sedation use and discharge analgesia in subcutaneous implantable defibrillator implantation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Mistry ◽  
V Poornanachandran ◽  
H Dhutia ◽  
R Chelliah ◽  
R Pathmanathan
Keyword(s):  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Icd Implantation ◽  
Ventricular Ejection Fraction ◽  
Perioperative Analgesia ◽  
The Mean ◽  
Anterior Plane

Abstract Funding Acknowledgements Type of funding sources: None. Background The subcutaneous implantable cardioverter defibrillator (S-ICD) has now become a well-recognised alternative to traditional devices and can be used as a first-line option, avoiding the risks associated with a transvenous lead. Standard implantation is either performed under general anaesthesia or under sedation. Ultrasound-guided serratus anterior plane block (SAPB) has recently been introduced to provide periprocedural anaesthesia and analgesia. Purpose To assess whether SAPB reduces periprocedural analgesia/anaesthesia and post-operative analgesia in S-ICD implantation compared with standard perioperative analgesia/anaesthesia. Methods One hundred and twenty patients eligible for ICD implantation for standard indications were offered a S-ICD over a five-year period (2014-2019) at a single tertiary cardiac centre. From July 2014 to September 2018, consecutive cases were performed with standard analgesia/anaesthesia and performed using a standard two-incision technique. From October 2018 onwards, SAPB was performed in addition to standard perioperative analgesia/anaesthesia. This involved ultrasound-guided infiltration of 50ml prilocaine into the interfascial plane between the serratus anterior muscle and latissimus dorsi at the mid axillary line over the level of the 5th rib. Collection of data was performed at the six-week follow up with all data obtained from routinely collected local registry. Results The mean age at implant was 52.0 years (+15.9 years) and 102 (85.0%) were male. The mean body mass index was 27.9 (+5.2). 85 (70.8%) had a primary prevention indication. 64 (52.3%) patients had a left ventricular ejection fraction (LVEF) of <35%. 79 (65.8%) patients underwent standard implantation without SAPB (SAPB-) and 41 (34.2%) patients with SAPB (SAPB+). There were no significant differences in age, sex, BMI, left ventricular ejection fraction, comorbidities, aetiology and indication between SAPB- and SAPB+ cohorts. In the SAPB+ cohort, a greater proportion were performed using conscious sedation (97.5% vs 84.8%; p = 0.036) with a lower required dose of midazolam (3.3mg vs 6.4mg; p < 0.001). 34 (83%) patients in the SABP+ cohort required no analgesia at discharge compared for 42 (53.2%) in the SAPB- cohort (p = 0.042). There was a trend towards lesser use of periprocedural morphine (6.2mg vs 7.4mg; p = 0.071) and reduced hospital stay (0.7 days vs 1.1 days; p = 0.102) in the SAPB+ cohort. The use of SAPB did not significantly increase total procedural time (63mins vs 57mins; p = 0.110), defined as the total duration for SAPB administration and S-ICD implantation. There were no periprocedural complications and no complications at follow up. Conclusion The use of SAPB significantly reduces the dose of sedation required for S-ICD implantation as well as the need for analgesia at discharge without a significant impact on procedure duration.

Ultrasound-guided parasternal Pecs block: a new and useful supplement to Pecs I and serratus anterior plane blocks

2016 ◽  
Author(s):  
Dr Christian Kruse Hansen ◽  
◽  
Dr Mette Dam ◽  
Dr Troels Dirch Poulsen ◽  
Dr Per-Arne Lönnqvist ◽  
...  
Keyword(s):  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Anterior Plane
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