Impact of Opioid Analgesia and Inhalation Sedation Kalinox on Pain and Radial Artery Spasm during Transradial Coronary Angiography
Abstract
:1. Introduction
2. Methods
2.1. Patients
2.2. Clinical Endpoints
2.3. Statistical Analysis
3. Results
3.1. Patients and Baseline Characteristics
3.2. Radial Artery Spasm
3.3. Pain Scale
3.4. Safety and Side Effects
4. Discussion
4.1. Radial Artery Spams Incidence and Risk Factors
4.2. Kalinox Effects
4.3. Study Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A. Contraindications for Use of Kalinox
- ▪
- Hypersensitivity to the active substance.
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- In patients with signs or symptoms of pneumothorax, pneumopericardium, severe emphysema, gas emboli or head injury.
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- Maxillofacial injuries.
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- Following deep sea diving with risk of decompression sickness (bubbles of nitrogen).
- ▪
- Following treatment with heart lung machine or coronary bypass without heart lung machine.
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- In patients recently having undergone intraocular injection of gas until the gas in question is fully absorbed, or within 3 months after the last injection of an intraocular gas, because the gas volume may increase in pressure/volume and consequently result in blindness.
- ▪
- Patients with a severely dilated gastrointestinal tract.
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- Following air encephalography.
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- During middle ear, inner ear and sinus surgery.
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- If air has been injected into the epidural space to determine the placement of the needle for epidural anesthesia.
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- In patients showing signs of confusion or in some other way showing signs of increased intracranial pressure.
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- Patients with untreated vitamin B12- or folic acid deficiency or diagnosed genetic disorder of the enzyme system involved in metabolism of these vitamins.
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- Patients with a decreased level of consciousness or impaired ability to cooperate and follow instructions due to the risk that further sedation from the nitrous oxide may affect natural protective reflexes.
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- Patients with facial injury where use of a face mask may present difficulties or risks.
References
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Variable | Opioid Analgesia (n = 185) | Kalinox (n = 140) | p Value |
---|---|---|---|
Age—years | 66.8 ± 11.9 | 63.2 ± 11.3 | 0.060 |
Size—cm | 169.7 ± 9.2 | 171.4 ± 9.4 | 0.104 |
Weight—kg | 80.4 ± 17.1 | 81.3 ± 15.5 | 0.618 |
Male—n (%) | 128 (69.2) | 110 (78.6) | 0.059 |
Diabetes mellitus—n (%) | 58 (31.4) | 30 (21.4) | 0.032 |
Insulinotherapy—n (%) | 15 (8.2) | 9 (6.4) | 0.557 |
Hypertension—n (%) | 105 (56.8) | 75 (53.6) | 0.567 |
Smoking—n (%) | 93 (50.3) | 88 (62.9) | 0.024 |
Current smoking—n (%) | 29 (15.7) | 42 (30.0) | 0.002 |
Hyperlipidemia—n (%) | 95 (51.4) | 68 (48.6) | 0.620 |
Known CAD—n (%) | 87 (47) | 63 (45) | 0.717 |
PAD—n (%) | 9 (4.9) | 17 (12.1) | 0.017 |
RAS score—IU | 2.4 ± 1.6 | 2.6 ± 1.7 | 0.455 |
LVEF—n (%) | 55.7 ± 10.3 | 56.2 ± 10.8 | 0.672 |
≤35% | 3 (1.7) | 1 (0.8) | |
36–40% | 7 (4.0) | 3 (2.3) | 0.713 |
41–50% | 17 (9.8) | 12 (9.2) | |
≥50% | 146 (84.4) | 115 (87.8) | |
eGFR—mL/min | 74.9 ± 17.4 | 76.4 ± 17.9 | 0.437 |
eGFR—n (%) | |||
<30 mL/min | 0 | 0 | |
30 to 60 mL/min | 30 (16.5) | 17 (12.6) | 0.626 |
60 to 90 mL/min | 82 (45.1) | 63 (46.7) | |
eGFR >90 mL/min | 70 (38.5) | 55 (40.7) |
Variable | Opioid Analgesia (n = 185) | Kalinox (n = 140) | p Value |
---|---|---|---|
Indication of PCI— n (%) | |||
Heart failure | 9 (4.9) | 11 (7.9) | 0.266 |
Programmed angioplasty | 20 (10.8) | 11 (7.9) | 0.369 |
Post-angioplasty control | 6 (3.2) | 8 (5.7) | 0.277 |
Pre-operative exam | 12 (6.5) | 9 (6.4) | 0.983 |
Silent ischemia | 53 (28.6) | 36 (25.7) | 0.557 |
NSTEMI | 19 (10.3) | 14 (10) | 0.936 |
STEMI | 3 (1.7) | 2 (1.4) | 0.732 |
Stable Angina | 38 (20.5) | 30 (21.4) | 0.845 |
Valvular heart disease | 14 (7.6) | 11 (7.9) | 0.923 |
Dyspnea | 6 (3.2) | 2 (1.4) | 0.293 |
Heart rhythm disorder | 2 (1.1) | 7 (5) | 0.033 |
Height of radial puncture—n (%) | |||
4F | 3 (1.6) | 4 (2.9) | 0.447 |
5F | 104 (56.2) | 88 (62.9) | 0.228 |
6F | 79 (42.7) | 48 (34.3) | 0.124 |
Iode volume—mL | 76.7 ± 69.3 | 86.6 ± 58.4 | 0.176 |
Procedural time—min | 23 ± 17.4 | 22.5 ± 17.8 | 0.798 |
Height of introducer—n (%) | |||
4F | 6 (3.2) | 8 (5.7) | 0.277 |
5F | 110 (59.5) | 90 (64.3) | 0.376 |
6F | 69 (37.3) | 42 (30) | 0.170 |
Type of introducer—n (%) | |||
Short | 176 (95.1) | 136 (97.1) | 0.487 |
Long hydrophilic | 9 (4.9) | 4 (2.9) | 0.360 |
Difficulty of puncture—n (%) | |||
One puncture | 162 (87.6) | 124 (88.6) | |
One to three punctures | 17 (9.2) | 12 (8.6) | 0.960 |
More than three | 6 (3.2) | 4 (2.9) | |
Kind of needle—n (%) | |||
19 Gauges | 155 (83.8) | 124 (88.6) | 0.220 |
M Coat | 1 (0.5) | 1 (0.7) | 0.843 |
Plastic cathlon | 29 (15.7) | 15 (10.7) | 0.195 |
Severity of CAD—n (%) | |||
1-vessel disease | 75 (29.1) | 72 (28.1) | 0.791 |
2-vessel disease | 58 (22.6) | 43 (16.8) | 0.100 |
3-vessel disease | 30 (11.7) | 30 (11.7) | 0.997 |
Variables | HR | CI 95% | p Value |
---|---|---|---|
Age < 50 years | 1.21 | 0.39–3.69 | 0.734 |
BMI < 25 kg/m2 | 2.09 | 1.06–4.10 | 0.031 |
Height < 170 cm | 1.26 | 0.65–2.45 | 0.492 |
Female gender | 3.20 | 1.62–6.30 | 0.001 |
Diabetes mellitus | 1.18 | 0.57–2.46 | 0.640 |
Insulinotherapy | 0.96 | 0.27–3.39 | 0.960 |
Hypertension | 0.97 | 0.50–1.89 | 0.940 |
Smoking | 0.97 | 0.50–1.89 | 0.940 |
Current smoking | 1.42 | 0.67–3.02 | >0.350 |
Hyperlipidemia | 1.10 | 0.57–2.14 | 0.760 |
Known CAD | 1.87 | 0.95–3.68 | 0.060 |
PAD | 1.27 | 0.41–3.88 | 0.670 |
LVEF | 1.01 | 0.98–1.04 | 0.480 |
CKD | 0.99 | 0.97–1.01 | 0.330 |
RAS score | 1.13 | 0.94–1.36 | 0.192 |
High risk RAS score | 1.40 | 0.69–2.84 | 0.339 |
Procedure duration | 1.018 | 1.002–1.035 | 0.020 |
Kalinox use | 0.71 | 0.355–1.424 | 0.336 |
Height of introducer | |||
5F | 0.46 | 0.24–0.91 | 0.020 |
6F | 2.62 | 1.33–5.16 | 0.005 |
Puncture difficulty | 2.55 | 1.44–4.5 | 0.001 |
Supplementary dose of Nicardipine | 0.4 | 0.21–0.75 | 0.005 |
Metallic 19 G Needle | 0.31 | 0.14–0.67 | 0.003 |
Plastic cathlon | 2.47 | 1.11–5.5 | 0.020 |
Pain Scale ≥5 | 3.28 | 1.46–7.38 | 0.004 |
Variables | HR | CI 95% | p Value |
---|---|---|---|
Female gender | 3.15 | 1.45–6.85 | 0.004 |
BMI < 25 kg/m2 | 2.09 | 0.999–4.40 | 0.050 |
Plastic cathlon | 2.63 | 1.07–6.46 | 0.035 |
6F introducer | 2.89 | 1.23–6.82 | 0.015 |
Puncture difficulty | 2.14 | 1.13–4.04 | 0.019 |
Pain Scale ≥5 | 2.17 | 0.93–5.07 | 0.070 |
Procedure duration | 1.01 | 0.99–1.03 | 0.300 |
Variables | HR | CI 95% | p Value |
---|---|---|---|
Age < 50 years | 1.36 | 0.49–3.74 | 0.550 |
Weight < 60 kg | 1.36 | 0.49–3.78 | 0.550 |
Female gender | 2.15 | 1.12–4.10 | 0.020 |
Diabetes mellitus | 1.07 | 0.53–2.15 | 0.830 |
Insulinotherapy | 1.17 | 0.38–3.57 | 0.780 |
Hypertension | 0.69 | 0.37–1.30 | 0.250 |
Smoking | 0.94 | 0.50–1.77 | 0.860 |
Current smoking | 1.15 | 0.55–2.40 | 0.700 |
Hyperlipidemia | 1.48 | 0.78–2.79 | 0.220 |
Known CAD | 0.87 | 0.46–1.64 | 0.670 |
PAD | 0.74 | 0.21–2.57 | 0.640 |
LVEF | 1.06 | 0.97–1.03 | 0.690 |
CKD | 1.01 | 0.99–1.03 | 0.210 |
Angor | 2.33 | 1.18–4.60 | 0.010 |
RAS score | 1.10 | 0.92–1.32 | 0.260 |
High risk RAS score | 1.40 | 0.69–2.84 | 0.339 |
Kalinox use | 0.66 | 0.34–1.27 | 0.222 |
Procedure duration | 1.01 | 0.99–1.02 | 0.230 |
Introducer 5F | 0.52 | 0.28–0.98 | 0.040 |
Spasm | 2.72 | 1.24–5.92 | 0.012 |
Variables | HR | CI 95% | p Value |
---|---|---|---|
Female gender | 1.81 | 0.92–3.55 | 0.083 |
Angor as indication of PCI | 2.22 | 1.11–4.44 | 0.023 |
Radial Spasm | 2.28 | 1.01–5.15 | 0.046 |
Variables | Opioid Analgesia (n = 185) | Kalinox (n = 140) | p Value |
---|---|---|---|
Nausea/vomiting—n (%) | 3 (1.6) | 4 (2.9) | 0.44 |
Dizziness/faintness—n (%) | 16 (8.6) | 7 (5) | 0.20 |
Headache—n (%) | 0 (0.0) | 9 (6.4) | 0.002 |
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Birgy, C.; Trimaille, A.; Messas, N.; Ristorto, J.; Kayali, A.; Marchandot, B.; Cardi, T.; Hess, S.; Kibler, M.; Jesel, L.; et al. Impact of Opioid Analgesia and Inhalation Sedation Kalinox on Pain and Radial Artery Spasm during Transradial Coronary Angiography. J. Clin. Med. 2020, 9, 2747. https://doi.org/10.3390/jcm9092747
Birgy C, Trimaille A, Messas N, Ristorto J, Kayali A, Marchandot B, Cardi T, Hess S, Kibler M, Jesel L, et al. Impact of Opioid Analgesia and Inhalation Sedation Kalinox on Pain and Radial Artery Spasm during Transradial Coronary Angiography. Journal of Clinical Medicine. 2020; 9(9):2747. https://doi.org/10.3390/jcm9092747
Chicago/Turabian StyleBirgy, Caroline, Antonin Trimaille, Nathan Messas, Jessica Ristorto, Anas Kayali, Benjamin Marchandot, Thomas Cardi, Sébastien Hess, Marion Kibler, Laurence Jesel, and et al. 2020. "Impact of Opioid Analgesia and Inhalation Sedation Kalinox on Pain and Radial Artery Spasm during Transradial Coronary Angiography" Journal of Clinical Medicine 9, no. 9: 2747. https://doi.org/10.3390/jcm9092747