[Anesthetic management for nephrectomy using a monopolar electrocautery in a patient implanted with a biventricular...

A 72-year-old man implanted with a biventricular pacemaker was diagnosed pyonephrosis, and left nephrectomy was performed under general and epidural anesthesia. Urologists were going to use a monopolar electrocautery during the operation. Before the operation, we attempted to convert the pacemaker from DDD mode to DOO mode with a precordial magnet because we wanted to know the effect of DOO mode in this patient implanted with a biventricular pacemaker and how a monopolar electrocautery interfered the biventricular pacemaker. His blood pressure and heart rate were stable during DOO mode by a precordial magnet, but the stroke volume was reduced a little. Then, we suggested surgeons the minimal use of the monopolar electrocautery. Actually, intraoperative use of the monopolar electrocautery did not interfere his pacemaker, and the operation was completed uneventfully. Recently in Japan, cardiac resynchronization therapy (CRT) becomes more common and operations in the patients implanted with biventricular pacemakers will become more frequent. The surgeons and anesthesiologists should take in mind that the monopolar electrocautery is appropriate or not depending on the individual patient.