Implantable cardioverter defibrillator

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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

References