121 Safe sedation in elderly patients with dementia

Résumé fourni par la source

Background With increased longevity of our population, there is higher prevalence of degeneration of the cardiac conduction system. This consequently leads to a growing increase in the use of pacemakers in elderly patients as fall prevention is vital. Alongside the ageing heart, dementia is a concern in the elderly population. Although most pacemakers are implanted under local anaesthesia, in elderly patients with dementia undergoing pacemaker implantation, it is sometimes necessary to use sedation to allow operational safety. At present, there are no national guidelines on the use of safe sedation in elderly patients with dementia for pacemaker implantation. Thus, there is a need for NHS trusts to have clear written guidelines on this area. Methods and Results To assess current practice, we performed a retrospective analysis of 1000 patients above the age of 70 years who received a pacemaker implantation between April 2019 to April 2021. 67 patients were identified to have dementia documented on either their regional patient care records, admission clerking or clinic letters. 35 patients (52%) required sedation and surprisingly, 17 patients (25%) underwent general anaesthesia. None of the patients had adverse events documented. Midazolam and fentanyl were independently used for sedation and were shown to be safe agents to be used for conscious sedation if non-pharmacological techniques are unsuccessful. Implications Based on this data, working together with the care of the elderly team, we have produced a trust guideline to guide safe sedation in elderly patients with dementia undergoing pacemaker implantation which incorporates both non-pharmacological and pharmacological strategies to allow operational safety. Conflict of Interest None

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.