Difference between revisions of "Insertion of pacemaker or ICD"
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=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
There is very little stimulation after pocket is made. Due to length of procedure, consider at propofol infusion (25-100 mcg/kg/min) and precedex infusion (0.6-1 mcg/kg/hr). After pocket creation, propofol infusion can slowly be weaned off. | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
Latest revision as of 08:30, 8 August 2022
| Anesthesia type |
MAC |
|---|---|
| Airway |
Natural |
| Lines and access |
1-2 PIV |
| Monitors |
5 lead EKG |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Pacemaker or ICD placement is a minimally invasive procedure were a small incision below the clavicle is created and a cardiac pacemaker or ICD is placed. Through this pocket the cardiologist will insert a wire into the RV of the heart. Once the device is tested and functional, the pocket is closed and local is typically injected in the field.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | Consider etiology requiring pacemaker/ICD insertion. Symptomatic bradycardia, high degree heart blocks, sick sinus syndrome, syncope, HF are some of the common causes. |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
1-2 PIVs are typically required
Standard ASA monitoring
Induction and airway management
Natural airway typically utilized. If concerns for obstruction or other considerations, LMA or ETT can be considered.
Positioning
Supine
Maintenance and surgical considerations
There is very little stimulation after pocket is made. Due to length of procedure, consider at propofol infusion (25-100 mcg/kg/min) and precedex infusion (0.6-1 mcg/kg/hr). After pocket creation, propofol infusion can slowly be weaned off.
Emergence
Postoperative management
Disposition
PACU
Pain management
Minimally invasive with local injection in field.
Potential complications
Arrhythmias, pneumothorax, heart perforation, bleeding
Later complications include pericarditis, lead dislodgement, device migration, venous thrombosis, hematoma
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |