Procedural propofol sedation with ketamine versus alfentanil and remifentanil in patients for cardiac ablation.

We hypothesize that propofol combined with ketamine has an optimal respiratory stability with a significant decrease in respiratory side effects and complications, in comparison with propofol combined with either alfentanil or remifentanil.

T = 0 Before induction

 Hemodynamic parameters

 Demographic parameters

 Medical and physical history

T = 1 Start of induction of PSA

T = 2 End of induction (OAA/S ≤ 3)

 Hemodynamic parameters

 Respiratory parameters

 Sedation score

 Total doses of medications administered

T = 3 Start of the procedure

T = 4 (4.1 – 4.9) Repeated every 15 minutes during the procedure

 Hemodynamic parameters

 Respiratory parameters

 Sedation score

 Total doses of medications administered

 Time

T = 5 End of the procedure

T = 6 End of PSA

 Hemodynamic parameters

 Respiratory parameters

 Sedation score

 Total doses of medications administered

 Aldrete score

 Pain score

T = 7 During recovery (every 15 minutes) until Aldrete score > 8

 Hemodynamic parameters

 Respiratory parameters

 Sedation score

 Total doses of medications administered

 Aldrete score

 Pain score

T = 8 After discharge of the patient / procedure

 Patient’s satisfaction

 Physician’s satisfaction

For sedation, a propofol perfusor will be started at 2 mg/kg/h, with an induction bolus of 0,5 mg/kg. Contemporaneously with propofol, ketamine will be administered via a perfusor at 0,3 mg/kg/h, with an induction bolus of 0,1 mg/kg. During the procedure, doses of propofol and ketamine will be fitted to the clinical situation, to reach and maintain an Observer’s Assessment of Alertness/ Sedation (OAA/S) score of at least 3, a pain score on a Numeric Rating Scale (NRS) of at least 4 and to consider hemodynamic stability. Propofol will be dosed in a range of 1 – 4 mg/kg/h and ketamine in a range of 0,05 – 0,4 mg/kg/h.