[Implantable automatic cardioverter-defibrillator: anesthesia experience]

To evaluate the anesthetic management and intraoperative events in patients benefiting from an automatic implantable cardioverter defibrillator. We retrospectively reviewed the charts of 12 male patients in whom we had placed automatic implantable defibrillators (AID). In particular we assessed anesthetic management, recording type of anesthetic and intraoperative monitoring, the technique used to implant the AID and complications during and after surgery. Arterial pressure and heart rate were also analyzed. All patients experienced tachyarrhythmia or ventricular fibrillation. Ten of the 12 patients presented left ventricular ejection fractions (LVEF) between 21 and 28%; LVEF in the other 2 patients exceeded 30% (45 and 62%). All experienced statistically significant decreases in arterial pressure coincident with fibrillation. Three patients required dobutamine for sustained hypotension. Six presented ventricular extrasystoles during surgery. Late complications included 1 sudden death after surgery and 1 infection which obliged removal of the AID. AID implantation is not risk-free, given that the patients involved have heart disease with considerable degrees of deterioration in myocardial function. Nevertheless, with extensive preoperative examination of the patient and proper anesthetic management, complications before and after surgery are rare.