Introduction: Modern cardiac catheterization laboratories and coronary care units (CCU) require sophisticated sedation protocols that balance patient comfort with hemodynamic stability and respiratory safety (1). This review presents sedation options currently implemented at General Hospital Slavonski Brod’s CCU.
Protocols and Methods: We analyzed seven primary sedation agents used in our institution: propofol and propofol TCI (Target-Controlled Infusion), remifentanil TCI, dexmedetomidine, sufentanil, fentanyl, and midazolam. Each agent’s pharmacokinetics, pharmacodynamics, indications, contraindications, and adverse effects were systematically reviewed based on current literature and institutional experience (Table 1 andTable 2). Our sedation protocols are tailored to specific procedures: propofol for electrical cardioversion due to rapid onset and recovery (2); midazolam combined with propofol for transcatheter aortic valve implantation procedures; dexmedetomidine for mechanically ventilated patients post-cardiac arrest or myocardial infarction; and dexmedetomidine-based protocols for anxious elderly patients and non-invasive ventilation (NIV) mask tolerance enhancement (3,4). Each approach considers patient-specific factors including age, comorbidities, and procedural complexity. Propofol demonstrates rapid onset (30-40 seconds) with significant cardiovascular depression but predictable recovery. TCI systems provide superior concentration control and reduced side effects. Remifentanil TCI offers precise analgesia control with ultra-short elimination half-life (3-10 minutes) but requires vigilant respiratory monitoring. Dexmedetomidine provides unique conscious sedation with minimal respiratory depression, making it ideal for prolonged sedation and NIV tolerance (3,4). Traditional opioids (fentanyl, sufentanil) and midazolam remain valuable for specific indications with established safety profiles. Each agent presents distinct contraindication patterns. Propofol requires caution in cardiac failure and hypovolemia (2). Dexmedetomidine necessitates monitoring for bradycardia and hypotension. Opioids demand respiratory surveillance, while midazolam may cause paradoxical reactions in elderly patients.
Conclusions: Successful sedation in cardiac catheterization laboratories and coronary units require individualized approaches based on pharmacological understanding, procedural requirements, and patient characteristics. Our institutional experience demonstrates that combined protocols utilizing multiple agents can optimize patient outcomes while maintaining safety. Continuous monitoring and staff education remain paramount for safe sedation practice.