Pacemaker

Pacemaker

Anesthesia type	MAC, rarely general
Airway	Natural airway, nasal canula or facemask with EtCO2 monitoring
Lines and access	PIV
Monitors	5 lead EKG
Primary anesthetic considerations
Preoperative	Arrhythmia
Intraoperative	Arrhythmia
Postoperative
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A minimally invasive surgical procedure that involves placement of a cardiac pacemaker in a small subcutaneous pocket typically in the upper chest below the clavicle. Through the pocket, pacing leads are placed into the subclavian vein and guided into the heart under fluoroscopy. The leads are then tested and activated.

Pacemakers can consist of a single or multiple leads for single chamber or multi chamber pacing.

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Intraoperative management

Monitoring and access

Generally 1 or 2 peripheral IVs are sufficient.

5 lead EKG monitoring for arrhythmia

Induction and airway management

Most often the procedure is done under monitored anesthesia care, very rarely requires general anesthesia.

Often a natural airway is used with a nasal canula or facemask with EtCO2 monitoring. Consider oral or nasal airway if signs of upper airway obstruction.

Positioning

Supine with arms out

Maintenance and surgical considerations

IV sedation. Consider midazolam, fentanyl, propofol, or other medications.

Postoperative management

Pain management

Intraop fentanyl or other opioid. Acetaminophen.

Typically cardiologist injects local anesthetic into the field.

Potential complications

Pneumothorax, pericarditis, heart perforation, infection, air embolism, arrhythmia

Lead dislodgment

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications