Anaes SAQs · Perioperative medicine
Perioperative management of pacemakers and ICDs
Final-examination SAQ for pacemaker-icd-perioperative.
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Assessment (4). Device type/indication, manufacturer card, last interrogation, battery/leads, underlying rhythm and pacing dependence, rate-response sensors, surgical site relative to generator, expected EMI (monopolar vs bipolar).[1][3]
EMI mitigation (3). Prefer bipolar; if monopolar, return pad path not across generator/heart, short bursts, distance from generator, continuous monitoring of pulse/ECG.[2]
Pacemaker-dependent strategy (4). Asynchronous pacing via magnet or formal reprogramming; external pacing/defib pads available; stop diathermy if inhibition occurs.[1][3]
ICD strategy (4). Suspend tachy therapies (reprogram or magnet), external pads on, re-enable therapies and re-interrogate/document postoperatively; monitored care until restored.[1][2]
References4ShowHide
- [1]American Society of Anesthesiologists Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter-Defibrillators 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Erratum Anesthesiology, 2020.PMID 32032098
- [2]Crossley GH, et al. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm, 2011.PMID 21722856
- [3]Stone ME, Salter B, Fischer A Perioperative management of patients with cardiac implantable electronic devices. British Journal of Anaesthesia, 2011.PMID 22156267
- [4]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.