Anaes Cases · Electricity, diathermy & theatre safety
Anaesthesia for surgery with a cardiac pacemaker
The long case — the pacemaker-dependent patient needing the monopolar diathermy. The preoperative device review, the diathermy precautions (the bipolar if possible, the plate placement, the short bursts), the magnet and the defibrillator preparation, and the postoperative re-interrogation.
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Prompt
A 74-year-old man with a dual-chamber pacemaker (pacemaker-dependent) for a total hip replacement where the surgeon plans to use the monopolar diathermy. Discuss the perioperative plan.
Presentation
A 74-year-old man, ASA 3, for an elective total hip replacement. He has a dual-chamber pacemaker implanted three years ago for the complete heart block; he is pacemaker-dependent (no underlying intrinsic rhythm). The surgeon intends to use the monopolar diathermy for the haemostasis. Discuss the perioperative management of the diathermy and the device.
References2ShowHide
- [5]Chacko S, et al. Diathermy-induced ventricular fibrillation. J Innov Card Rhythm Manag, 2021.PMID 33654572
- [33654573]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.