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


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<!-- 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.
=== 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. --> ===
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
Intraop fentanyl or other opioid. Acetaminophen.
Typically cardiologist injects local anesthetic into the field.
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
Pneumothorax, pericarditis, heart perforation, infection, air embolism, arrhythmia
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]]

Latest revision as of 07:49, 24 February 2022

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
Article quality
Editor rating
Unrated
User likes
0

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

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.

Emergence

Postoperative management

Disposition

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

References

Top contributors: Mitchel DeVita

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