[Anesthetic management of a patient implanted with a CRT-P device undergoing laparoscopic nephrectomy]

A 76-year-old man implanted with a CRT-P device (cardiac resynchronization therapy pacemaker) was diagnosed with renal tumor by chance. Right laparoscopic nephrectomy was performed under general and epidural anesthesia. Urologists were going to use a monopolar electrocautery during the operation. Before beginning the operation, we converted his pacing mode from DDD to DOO with a precordial magnet because electrocautery has the potential for causing device reset. His blood pressure and heart rate were stable during DOO mode. When the former CRT-P, for example InSync8040 (Medtronic) which we reported in 2009, was converted from DDD mode to DOO mode, the optimal atrioventricular (AV) delay had become invalid in DOO mode. In this case, new device Syncra (Medtronic) which had been marketed in March 2011 was implanted. DOO mode could be used keeping the optimal AV delay and right ventricular-left ventricular delay and the effect of cardiac resynchronization was valid. New CRT-P could be managed as single chamber or double chamber pacemaker. Recently in Japan, CRT becomes more common and operations in the patients implanted with CRT-P or CRT-D (CRT with defibrillation) will become more frequent. CRT will require attention for anesthetic management.