Pacemakers and implantable cardioverter defibrillators – general and anesthetic considerations

Abstract

A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia), special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary.

Towards Implantable Body Sensor Networks - Performance of MICS Band Radio Communication in Animal Tissue

“…Anatomically, the near-surface implantable devices are implanted in between the dermis and subcutaneous layer of the skin [2,3,17]. The dermis layer, as shown in Fig.…”

Favorable safety experience of local dental anesthesia in ICD recipients with channelopathies

“…Implantable cardioverter defibrillator (ICD) detects ventricular tachycardia (VT) and ventricular fibrillation (VF) and delivers therapy in the form of overdrive antitachycardia pacing (ATP), low-energy cardioversion, and high-energy defibrillation 1 . It is indicated for patients at high risk for malignant ventricular tachyarrhythmias (primary prophylaxis) and in patients who have survived from a malignant ventricular tachycardia (secondary prophylaxis) 2 .…”

An uncommon intraoperative implantable cardiac device complication and subsequent troubleshooting

“…Studies have shown that electrosurgical units are most common form of electromagnetic interference (EMI) in the operating room (OR). [ 2 3 ]…”

“…EMI from electrocautery can result in pulse generator inhibition or component failure, atrial or ventricular tachycardia and fibrillation, loss of/change in output, reprogramming of rate or mode of function, runaway pacing and electrical burns at the myocardial-electrode interface. [ 2 ]…”

“…Studies have shown that Monopolar devices cause far more EMI then bipolar. [ 2 3 ] In monopolar electrocautery, current must dissipate through the body and return to generator via the return electrode called electrodispersive pad (falsely known as grounding pad). [ 1 ] Bipolar coagulation cautery causes minimal problems as the current flow is localized between the two poles of the instrument.…”