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The patient with a pacemaker or related device
1Department of Anaesthesia, University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario.
Summary
Patients with pacemakers and implantable cardioverter-defibrillators (ICDs) can undergo surgery safely. Anesthetists must understand device modes and implement specific precautions for safe perioperative management.
Area of Science:
- Anesthesiology
- Cardiology
- Biomedical Engineering
Background:
- Patients with pacemakers and implantable cardioverter-defibrillators (ICDs) require careful perioperative management.
- Understanding device function and potential electromagnetic interference is crucial.
Purpose of the Study:
- To outline safe anesthetic management strategies for patients with pacemakers and ICDs.
- To highlight necessary precautions and device adjustments before surgery.
Main Methods:
- Review of pacemaker and ICD functionalities and interactions with surgical environments.
- Emphasis on preoperative assessment of patient's cardiac status and device settings.
- Guidelines for disabling specific device functions and preparing for emergencies.
Main Results:
- Pacemakers and ICDs are generally safe in the operating room but require specific precautions.
- Rate-responsive and antitachycardia pacing modes should be disabled preoperatively.
- External cardioversion/defibrillation capabilities and emergency pacing methods must be available.
Conclusions:
- Safe anesthetic management is achievable for patients with pacemakers and ICDs.
- Thorough understanding of device types and adherence to precautions are essential for patient safety.
- Anesthetists should develop personalized action plans for perioperative care.