Intraoperative Pacemaker Complications

Shapiro, William; Roizen, Michael F.; Singleton, Mark; Morady, Fred; Bainton, Cedric R.; Gaynor, Randall L.

doi:10.1097/00000542-198509000-00015

Cited by 42 publications

(21 citation statements)

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“…These patients may have unstable hemodynamics following termination of CPB, which can be accentuated by alterations in cardiac rhythm. In such a situation, electrocautery may inhibit or trigger the pacemaker in demand modes, and in patients with permanent pacemaker implants it may damage the pacing system or may cause the unit to go into its automatic safety reversion mode and can also cause thermal damage to the heart through the lead electrode 1,2 . An alternative in these circumstances is the use of bipolar electrocautery; however, this may lead to inadequate hemostasis and when used in superficial tissues, this inadequate hemostasis has the potential to produce wound hematoma and infection 7 .…”

Section: Discussionmentioning

confidence: 99%

“…The use of unipolar cautery in patients with temporary or permanent pacemakers can lead to electromagnetic interference with pacemaker malfunction that can trigger ventricular tachycardia or lead to asystole. Furthermore, there is potential for thermal burns 1‐3 . The ultrasonically activated scalpel (Harmonic scalpel, Ethicon Endo‐surgery, CVG, Cincinnati, OH, USA) is widely used in a wide range of general surgical procedures to achieve hemostasis and in hepatic resections to ensure a clean cut without producing significant hemorrhage 4,5 .…”

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confidence: 99%

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Ultrasonic Scalpel for Hemostasis in Pacemaker-Dependent Patients During Open-Heart Surgery

Talwar

Sharma

Choudhary

et al. 2010

Journal of Cardiac Surgery

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Ultrasonic Scalpel for Hemostasis in Pacemaker-Dependent Patients During Open-Heart Surgery

Talwar

Sharma

Choudhary

et al. 2010

Journal of Cardiac Surgery

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“…This has previously been reported as a complication in an adult patient undergoing surgery. 5 The very small infant is more dependent than an adult on a high heart rate to maintain adequate cardiac output, and the default rate may be inadequate. In our patient, a rate of 75 bpm maintained adequate perfusion for 90 min but was not well-tolerated after that.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative pacemaker failure in an infant

Bailey

Lacey

1991

Can J Anaesth

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We report a type of pacemaker failure occurring in an infant undergoing major abdominal and thoracic surgical procedures. The combination of a relatively slow back-up mode, use of monopolar electrocautery and a lack of familiarity with this pacemaker led to a need for isoproterenol support while awaiting reprogramming. Case reportThe patient was a 9-mo-old, 4 kg infant who had previously undergone repair of oesophageal atresia with tracheoesophageal fistula shortly after birth and repair of VSD at two months of age. She had an oesophageal stricture and gastroesophageal reflux which lead to transfer to our institution for operative repair. The VSD Key wordsANAESTHESIA: paediatric; HEART: pacemakers, artificial. Accepted for publication 17th May, 1991. CAN J ANAESTH 1991 / 38:7/pp912-3 repair had resulted in complete heart block which required a unipolar pacemaker (Intermedics Nova II, Model 281-05, Charlotte, North Carolina). She had also suffered a severe scalp IV infiltration with skin necrosis. Her initial operation at our centre was for placement of a Broviac catheter and debridement of the scalp wound. A standard monopolar electrocautery was used without incident.Two weeks later, she returned to the operating room for Nissen fundoplication and gastrostomy. Noninvasive blood pressure, lead II ECG, and pulse oximetry were placed prior to induction of anaesthesia. The ECG documented appropriate pacemaker function with all paced beats at a rate of 125 bpm. The blood pressure was 110/50. Following rapid sequence induction of anaesthesia and relaxation with tracheal intubation, anaesthesia was maintained with isoflurane and relaxation with pancuronium. Because blood loss with this procedure was not anticipated to be very great, electrocautery was not used in order to avoid pacemaker complications. The operative procedure was initally uneventful, but passage of the dilator produced an oesophageal perforation. The patient remained haemodynamically stable during completion of the abdominal procedure.In preparation for the oesophageal repair, an arterial line was placed, and the patient was turned to the lateral decubitus position with the grounding pad for the electrocautery on the patient's lower back. As the electrocautery had been used without incident for scalp debridement, it was used again during the thoracotomy to repair the perforation. Initially, pacemaker function was inhibited by bursts of cautery, but function returned after its discontinuation. Following one prolonged burst, pacemaker function returned at a rate of 75 bpm. A magnet was applied over the generator but without effect. Atropine also had no effect. Blood pressure and urine output remained adequate during the remainder of the procedure in spite of the relative bradycardia.Following surgery, the patient was taken to the paediatric intensive care unit. A representative of Intermedics was called to reprogram the pacemaker. Isoproterenol was used while awaiting reprogramming, as capillary refill became prolonged and urine output fell in spite o...

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“…Such an idea was suggested more than 25 years ago and would now be extremely helpful in taking care of ICU patients, especially if there is unexpected CIED behavior or an unusual magnet response. 4 A single interrogating device for all CIED would also be welcome.…”

Section: What Is That "Bump Under the Skin?" Is It A Cardiac Implantamentioning

confidence: 99%

Contemporary Developments in the Pacemaker World

Shapiro¹,

Witherell

2011

ICU Director

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ICU leaders need to be current with recent technological advances related to cardiac implantable electrical devices (CIEDs). This update will review the following 4 topics: (1) an update on contemporary technology for CIED companies headquartered in the United States, (2) unique features of one CIED company headquartered in Europe, (3) ICU considerations for patients with CIEDs for whom do not resuscitate orders are in place, and (4) evaluation of patients admitted to the ICU with incomplete medical information about a visible medical device that may be a CIED. This discussion will provide valuable information for the care of ICU patients with CIED.

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Intraoperative Pacemaker Complications

Cited by 42 publications

References 0 publications

Ultrasonic Scalpel for Hemostasis in Pacemaker-Dependent Patients During Open-Heart Surgery

Ultrasonic Scalpel for Hemostasis in Pacemaker-Dependent Patients During Open-Heart Surgery

Intraoperative pacemaker failure in an infant

Contemporary Developments in the Pacemaker World

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