Propofol for sedation for direct current cardioversion

Direct current cardioversion is a low-risk and standard procedure to restore normal sinus rhythm in patients with tachyarrhythmias. It requires sedation to facilitate the procedure, as it is painful and distressful. The preferred anesthetic drug must be short acting, producing conscious sedation, to enable rapid recovery after the procedure. In this sense, this narrative review focuses on the critical analysis of recent randomized studies and presents about the safety and effectiveness of propofol, comparing it with other established sedatives, mainly etomidate and midazolam. The research was performed on MEDLINE database with Propofol and Cardioversion keywords. In most cases, propofol comes to be the best option, with a quick recovery time and low rates of side effects. Different studies have demonstrated no inferiority when comparing to other drugs and, when these adverse events happened, they were easily and quickly handled. Exceptions in this scenario are those patients, particularly the elderly, with baseline important structural heart disease, in which etomidate with fentanyl has been pointed to lead to better hemodynamic stability.

Infections of Cardiac Implantable Electronic Devices: Diagnosis and Approach.

With the expansion of the indications for implantation of cardiac electronic devices, there was an increase in these procedures and, consequently, there was an increase of the infection rate. The risk of infection depends on many factors, including device type and the number of implantation procedures. In addition to significant morbidity, one-year mortality is approximately 20%. Knowledge of the factors associated with this unfavorable outcome, clinical manifestations, diagnosis and treatment are very important for proper approach. This review presents all these aspects and strategies for the prevention of infection related to implantable electronic cardiac devices.