Insertion of pacemaker or ICD
Anesthesia type

MAC

Airway

Natural

Lines and access

1-2 PIV

Monitors

5 lead EKG

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
Article quality
Editor rating
Unrated
User likes
0

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.

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular Consider etiology requiring pacemaker/ICD insertion. Symptomatic bradycardia, high degree heart blocks, sick sinus syndrome, syncope, HF are some of the common causes.
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

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.

Positioning

Supine

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

PACU

Pain management

Minimally invasive with local injection in field.

Potential complications

Arrhythmias, pneumothorax, heart perforation, bleeding

Later complications include pericarditis, lead dislodgement, device migration, venous thrombosis, hematoma

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References