The patient with a cardiac pacemaker or implanted defibrillator and management during anaesthesia
Marc A. Rozner
Preoperative key points
1 Have the pacemaker or defibrillator interrogated by a competent authority shortly before the anesthetic
2 Obtain a copy of this interrogation. Ensure that the device will pace the heart with appropriate safety margins
3 Consider replacing any device near its elective replacement period in a patient scheduled to undergo either a major surgery or surgery within 25cm of the generator
4 Determine the patient’s underlying rhythm/rate to determine the need for backup pacing support
5 Identify the magnet rate and rhythm, if a magnet mode is present and magnet use is planned
6 Program minute ventilation rate responsiveness off, if present
7 Program all rate enhancements off
8 Consider increasing the pacing rate to optimize oxygen delivery to tissues for major cases
9 Disable antitachycardia therapy if a defibrillator
Intraoperative key points
1 Monitor cardiac rhythm/peripheral pulse with pulse oximeter or arterial waveform
2 Disable the ‘artifact filter’ on the EKG monitor
3 Avoid use of monopolar electrosurgery
4 Use bipolar ESU if possible; if not possible, then pure cut (monopolar ESU) is better than ‘blend’ or ‘coag’
5 Place the ESU current return pad in such a way to prevent electricity from crossing the generator-heart circuit, even if the pad must be placed on the distal forearm and the wire overed with sterile drape
6 If the ESU causes ventricular oversensing, pacer quiescence, or tachycardia, limit the period(s) of asystole or reprogram the device
Postoperative key points
Have the device interrogated by a competent authority postop. Some rate enhancements can be re-initiated and optimum heart rate and pacing parameters should be determined. The ICD patient must be monitored until the antitachycardia therapy is restored.作者: ad221 时间: 2011-11-6 11:45
那位大侠翻译一下嘛。。。