Cardiology procedures increasingly are being performed in the electrophysiology (EP) laboratory.  The rapid expansion of these diagnostic and therapeutic procedures and the increasing complexity and comorbidities these patients exhibit necessitate increasing involvement and expertise among anesthesia providers.  Providing anesthesia in a safe and effective manner in the EP laboratory requires encountering a variety of challenges ranging from patient factors to case complexity to resource availability.

Demand for anesthesia services in the cardiac EP lab has been growing over the past several years.  A survey in 2011 among cardiologists analyzed sedation practice in EP labs in the U.S. and showed that some patients transitioned into deep sedation or general anesthesia often without any supervision from an anesthesiologist due to lack of availability or difficulty in scheduling.  These procedures are becoming increasingly complex, and patients range from being very stable to being critically ill and undergo light sedation to general endotracheal anesthesia.  Therefore, anesthesia providers must be prepared to handle the full range of case complexity.

Procedures done in an EP laboratory include the following: placement of permanent pacemaker for symptomatic bradycardia or heart block, radiofrequency ablation for tachyarrhythmias, implantable cardiac defibrillator (ICD) placement for primary and secondary prevention of sudden cardiac death, and lead extractions for pacemaker or ICDs.  Anesthesiology services are warranted for patients who have the possibility of a difficult airway, obesity, obstructive sleep apnea, congestive heart failure, pulmonary disease, hemodynamic instability, neuromuscular disorders, or those who require a general anesthetic.

EP laboratories traditionally have been designed without any focus on the anesthesia provider.  Space and accessibility for the anesthesiologist can be rather limited, an