Difference between revisions of "Implantable cardioverter defibrillator"

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{{Infobox surgical procedure
| anesthesia_type = MAC
| airway = Natural airway, nasal canula or facemask with EtCO2 monitoring
| lines_access = PIV
| monitors = 5 lead EKG
| considerations_preoperative = Decreased ejection fraction, arrhythmia
| considerations_intraoperative = Arrhythmia
| considerations_postoperative =
}}


Insertion of an automatic implantable cardioverter-defibrillator (AICD) is very similar to insertion of a cardiac [[Pacemaker|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<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
== Intraoperative management ==
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
Generally 1 or 2 peripheral IVs are sufficient.
5 lead EKG monitoring for arrhythmia
=== 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. --> ===
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<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
Supine with arms out
=== 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. --> ===
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<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
== Postoperative management ==
=== 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. --> ===
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
Pneumothorax, pericarditis, heart perforation, infection, air embolism, arrhythmia/cardiac arrest
Lead dislodgment
== 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). --> ==
{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}
== References ==
[[Category:Surgical procedures]]

Revision as of 08:00, 24 February 2022

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
Article quality
Editor rating
Unrated
User likes
0

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

References

Top contributors: Mitchel DeVita

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