Implantable cardioverter defibrillator
| Anesthesia type |
MAC |
|---|---|
| Airway |
Natural airway, nasal canula or facemask with EtCO2 monitoring |
| Lines and access |
PIV |
| Monitors |
5 lead EKG |
| Primary anesthetic considerations | |
| Preoperative |
Decreased ejection fraction, arrhythmia |
| Intraoperative |
Arrhythmia |
| Postoperative | |
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Insertion of an automatic implantable cardioverter-defibrillator (AICD) is very similar to insertion of a cardiac pacemaker. Main differences include the underlying pathology requiring defibrillator functionality such as HFrEF, VT, or VF. Procedurally, one the device is in place, the cardiologist will induce V-Tach or V-Fib to test the AICD device. The following shock will require a short term plane of deeper anesthesia.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| 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
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.
The cardiologist will alert you when they are ready to test the defibrillator. With a short acting medication, such as propofol, increase the depth of anesthesia. Be mindful of the patients underlying cardiac status, such as decreased ejection fraction during this time.
Emergence
Postoperative management
Disposition
PACU
Pain management
Potential complications
Pneumothorax, pericarditis, heart perforation, infection, air embolism, arrhythmia/cardiac arrest
Lead dislodgment
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |