Anesthetic implications of implanted pacemakers: a case study

Pacemakers and the underlying pathophysiologies leading to their implantation present challenges to the anesthetist. This case report discusses the anesthetic management of a patient with an implanted pacemaker. A case is presented of an 80-year-old female who was found unresponsive in a parking lot. She was diagnosed with a right parietal subdural hematoma. She underwent an emergency craniotomy for evacuation of the hematoma. Upon placing the patient on an electrocardiograph, a ventricular paced rhythm was revealed. Pacemakers are most frequently implanted to initiate electrical activity in a heart unable to maintain its own automaticity. Patients with pacemakers may be unable to react to situations requiring increased cardiac outputs by increasing the heart rate. Depending upon the type of pacemaker present, patients may suffer from diminished cardiac output due to the loss of the "atrial kick." Pacemakers can also be affected by electromagnetic interference from devices used during surgery, particularly the electrosurgical unit. This paper discusses anesthetic management in individuals with implanted permanent pacemakers.