Difference between revisions of "Insertion of pacemaker or ICD"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = MAC | ||
| airway = | | airway = Natural | ||
| lines_access = | | lines_access = 1-2 PIV | ||
| monitors = | | monitors = 5 lead EKG | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = | ||
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}} | }} | ||
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 == | == Preoperative management == | ||
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|- | |- | ||
|Cardiovascular | |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 | ||
| | | | ||
|- | |- | ||
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
1-2 PIVs are typically required | |||
Standard ASA monitoring | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
Natural airway typically utilized. If concerns for obstruction or other considerations, LMA or ETT can be considered. | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
Supine | |||
=== 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. --> === | ||
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=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | === Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | ||
PACU | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
Minimally invasive with local injection in field. | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
Arrhythmias, pneumothorax, heart perforation, bleeding | |||
Later complications include pericarditis, lead dislodgement, device migration, venous thrombosis, hematoma | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
Latest revision as of 08:30, 8 August 2022
Insertion of pacemaker or ICD
| 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 |