Insertion of pacemaker or ICD
|Lines and access||
5 lead EKG
|Primary anesthetic considerations|
Pacemaker or ICD placement is a minimally invasive procedure were a small incision below the clavicle is created and a cardiac pacemaker or ICD is placed. Through this pocket the cardiologist will insert a wire into the RV of the heart. Once the device is tested and functional, the pocket is closed and local is typically injected in the field.
|Cardiovascular||Consider etiology requiring pacemaker/ICD insertion. Symptomatic bradycardia, high degree heart blocks, sick sinus syndrome, syncope, HF are some of the common causes.|
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Monitoring and access
1-2 PIVs are typically required
Standard ASA monitoring
Induction and airway management
Natural airway typically utilized. If concerns for obstruction or other considerations, LMA or ETT can be considered.
Maintenance and surgical considerations
There is very little stimulation after pocket is made. Due to length of procedure, consider at propofol infusion (25-100 mcg/kg/min) and precedex infusion (0.6-1 mcg/kg/hr). After pocket creation, propofol infusion can slowly be weaned off.
Minimally invasive with local injection in field.
Arrhythmias, pneumothorax, heart perforation, bleeding
Later complications include pericarditis, lead dislodgement, device migration, venous thrombosis, hematoma
|Variant 1||Variant 2|