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Canadian Journal of Anaesthesia

, Volume 43, Supplement 1, pp R24–R41 | Cite as

The patient with a pacemaker or related device

  • Michael E. Bourke
Refresher Course Outline Track I

Summary

Patients with implanted pacemakers and ICDs can be safely managed for surgery and anaesthesia. Anaesthetic management of such patients should be planned first according to the patient’s underlying medical status with particular emphasis on ventricular function and electrolyte balance.

The anaesthetist must understand the various modes of pacemakers and ICDs available in the patient population. These devices are safe and well shielded form most electromagnetic interference in the operating room. Some precautions are nevertheless necessary. A magnet should not be placed routinely over a programmable pacemaker or ICD in the operating room, especially in the presence of electrocautery. Rate-responsive pacemakers should have rate adaptive modes disabled before surgery whenever possible. The mechanism of rate response should be known, so that inappropriate changes in heart rate can be avoided in the perioperative period if the rate responsive mode cannot for some reason be disabled. Antitachycardia pacemakers, should have the antitachycardia function disabled preoperatively. Methods for the provision of alternate emergency pacing should be available when dealing with patients at risk of bradyarrhythmias or pacemaker failure in the operating room. The anaesthetist should have a safe, practical plan of action that suites his/her experience and capabilities.

ICDs should have automatic cardioverter-defibrillator functions disabled for surgery and external modes of cardioversion/defibrillation should be available.

Keywords

Ventricular Tachycardia Ventricular Pace Pace Lead Pacemaker Lead Pacemaker Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le patient porteur d’un pacemaker ou d’un dispositif de même type

Résumé

L’anesthésie et la chirurgie des patients porteurs de pacemaker et de CDI peuvent être réalisée en toute sécurité. La gestion anesthésique de ces patients doit être planifiée en tenant compte de la condition médicale sous-jacente et en portant une attention particulière à la fonction ventriculaire et à l’équilibre électrolytique. L’anesthésiste doit connaître les différents modes de fonctionnement des pacemakers et des CDI disponibles. Ces appareils sont éprouvés et blindés efficacement contre la plupart des interférence électromagnétiques propres à la salle d’opération. En général, un aimant ne doit pas être placé au regard du pacemaker et du CDI en salle d’opération, surtout lorsqu’on utilise l’électrocautère. On devrait désactiver le mode sentinelle des pacemakers de ce type lorsque c’est possible. Son mécanisme doit être connu de façon à éviter les changements inappropriés de fréquence cardiaque à la période opératoire, si pour une raison ou une autre, on ne peut désactiver le mode sentinelle. La fonction antitachycardie des pacemakers qui opèrent selon ce mode doit être inactivée avant l’intervention. Des méthodes de rechange pour l’entraînement d’urgence doivent être disponibles lorsqu’on a la charge de patients à risque de bradyarythmies ou lors d’une panne du pacemaker en salle d’opération. L’anesthésiste doit avoir un plan d’action sûr et pratique adapté à son expérience et sa compétence.

Il faut désactiver le fonction de cardioversion-défibrillation automatique des CDI avant l’intervention et avoir à portée de main ce qu’il faut pour la cardioversion/défibrillation externe.

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Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  • Michael E. Bourke
    • 1
  1. 1.Department of AnaesthesiaUniversity of Ottawa Heart Institute, Ottawa Civic HospitalOttawa

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