Atrial Fibrillation & Implantation of Fiducials & Spaceoar at UCLA.

[JWS13]

I am presently setting up a new date for Spaceoar, Fiducials , and SBRT under IV SEDATION at UCLA with Dr. Kishan.

About three months ago I received a vaccine shot for Shingles and it caused 17 hours of AFIB at Cedars Sinai ER at a Heartrate of over 202 bpm. ( I received the shot at 2:45 pm and my Defibrillator records shows I went into the 17 hours at 2:56PM ,clearly a "one off" from the vaccine. ( I am not looking to blame anyone and not an anti-vaxxer -had both modernas covid and both boosters).

I just don't want to "poke the bear" (AFIB) and keep it a "one-off".

I discussed the AFIB with Dr. Kishan and he said to talk with anesthesiology. The problem is UCLA only uses CRNA's (Certified Nurse Anesthetists). That's their protocol.

I will be talking with their Anesthesiologist Department and their staff agreed that they would assign a Cardiac Anesthesiologist to my procedure and that would be ideal.

My question for this group is has anyone had the implantation of fiducials and spaceoar under iv sedation without incident TO THEIR AFIB and/or did you take any special precautions regarding your AFIB.

Secondly, my cardiac history is pretty significant as I was in Cardiac Arrest twice from Vasospasm 20 years ago and would feel a hell of a lot more comfortable with an assigned Cardiac Anesthesiologist monitoring my Afib and Vasospasm during the procedure. ( I have Cardiac Clearance for the procedure).

(I am not asking for medical advice, I want to do the SBRT at UCLA but at this point feel very uncomfortable with a Nurse Anesthetist handling the Anesthesia given my history and I don't want to be forced to go to some other facility where I can get the cardiac monitoring I need.

I don't know if UCLA being a state facility can alter their protocol of CRNA's and assign a Cardiac Anesthesiologist to monitor my procedure. (which would definitely make me mouch more comfortable- I am certainly willing to pay out of pocket for the Cardiac Anesthesiologist.)

Tall-Allen would appreciate your suggestions since you know Dr. Kishan and UCLA very well.

Gleason 7 (4-3), PSA 6.

Thanking you all in advance for all your responses. Any suggestions welcome.

[Yearofthecow]

I had SpaceOar put in with just local using lidocaine, and transperineal biopsy of the prostate with just lidocaine. The biopsy took out 15 cores.

To briefly answer your question, both procedures can be done under local, without any issues.

If I was concerned about Afib, I would have local done regardless.

[TylexGP]

Just as an FYI, I have Afib that is relatively well controlled. I had HDR Brachytherapy and the placement of Fiducials under general anesthesia with no issues with my Afib.

[JWS13 in reply to TylexGP]

thank you ..that helps ...appreciate it..

[Tall_Allen]

I would say that if you are taking an anticoagulant and have an anesthesiologist watching you, there is little risk. Since the insert SpaceOAR and fiducials transperineally, can't they just inject lidocaine into the pelvic plexus or periprostatic plexus (or both) to numb the entire region so that you won't need general anesthesia?

[maley2711]

I had a SEVERE pain problem when tried to have 1st transrectal biopsy...I had requested sedation but was refused ! For the 2nd try, at my request, I was given Propofol by IV and had no memories of the actual biopsy procedure. Propofol was also GREAT for my colonoscopy. At least for the dosage I had, Propofol not considered to be GA, no intubation and very quick recovery. Is that a possibility for you?? Propofol sedation......don't leave home without it!! Propofol plus local sedation should do the trick??? CRNA was present for that day procedure, but an anesthesiologist was supervising and available immediately.

[Farlo]

I don’t have experience with AFIB but have had Fiducials and SpaceOAR. Just wanted to reach out and let you know I agree with your concern to have a Cardio with you, wishing you less anxiety and a successful outcome.

[Hidden]

I've dealt with a-fib for years. Do you have a cardiologist? Is there some prescription he could provide that would act as a preventative to lessen the risk of an a-fib episode? I agree with previous comments that maybe local rather general anesthesia would be preferable. Good luck.

[JWS13 in reply to Hidden]

There is no prescription. TY

[Hidden in reply to JWS13]

Does your cardiologist know about your upcoming procedure and the concerns that you have about an a-fib episode? Time to rattle his cage?

[cancerfox]

I had fiducial markers implanted before IGRT and I just had a local anesthetic applied to the area. I was conscious the entire time. Don't know about SpaceOAR's, they never used one.

[bkjamjets]

We’re all different but the transperineal local done with skilled hands was a cakewalk for me. Did that for biopsy and hydrogel, no fiducials used. Just finished SBRT at UCLA two days ago. Really great experience.

Stay at The Tiverton (UCLA Medical owned hotel). I stayed there 25 nights, $179 per night, no tax, free underground parking. Drove 2 days to get there for treatment, wanted my car for exploring. Grocery across street, Target 3 minute walk, Med Center 5 minute walk. Loved exploring LA area, did lots of fun things, museums, went to the beach a lot, on and on. Driving home now.

Rad Onc docs, RT techs, RNs all awesome. I’m not on here much but you can email me at bkjamjets at gmail and we can phone call about it if you’d like. I type very slow, so I can’t commit to lengthy email exchanges. Happy to spend an hour on the phone with you though! Ben