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Anaesthesiology
Pacemaker and Implantable Cardiac Defibrillator Protocols
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
8 sections · 85 slides
Overview
- Scope of this topic
- Two device families
Pacemakers
- Function of a permanent pacemaker
- Pulse generator and lead
- Pacemaker and leads on chest radiograph
- Sinus node dysfunction as a pacing indication
- Atrioventricular block as a pacing indication
- Further conduction indications for pacing
- Non-conduction indications for pacing
- Paced rhythm on the electrocardiogram
- Reading the pacemaker code
- Generic pacemaker code positions
- Asynchronous versus demand pacing
Implantable cardiac defibrillators
- Structure of an implantable cardiac defibrillator
- Position of the defibrillator and its electrode
- Defibrillator generator and lead on chest radiograph
- Cardiac resynchronisation therapy device
- Secondary prevention indications for a defibrillator
- Genetic and syncopal indications for a defibrillator
- Reading the defibrillator code
- Generic defibrillator code positions
Intraoperative problems
- Electromagnetic interference in theatre
- Consequences of electromagnetic interference
- Effects of interference on device behaviour
- Further device failures reported in theatre
- Radiofrequency ablation and radiation therapy
- Interference from the retained-item scanning wand
Perioperative management
- Who makes the perioperative device plan
- Information exchange between the teams
- Interrogation intervals before surgery
- Information the anaesthesia team must supply
- Essential elements of the information given to the device physician
- Information the device team must return
- Essential elements of the preoperative device evaluation given to the operative team
- Reprogramming when interference is likely
- Magnet response of pacemakers and defibrillators
- Limitations of magnet use
- Consequences of inadequate preoperative device assessment
- Decision pathway for perioperative device management
- Reading the pacemaker branch of the algorithm
- Reading the defibrillator branch of the algorithm
- Risk mitigation strategies in theatre
- Bipolar versus monopolar electrosurgery
- Stepwise approach to perioperative management of the patient with a device
- Stepwise approach to perioperative management of the patient with a device (continued)
- Stepwise approach to perioperative management of the patient with a device (continued)
- Stepwise approach to perioperative management of the patient with a device (continued)
- Stepwise approach to perioperative management of the patient with a device (continued)
- Footnotes to the stepwise approach
- Anesthesia device services
- Findings of the anesthesia device service comparison
- Requirements for running a device service
Postoperative follow-up
- Principles of postoperative device evaluation
- Specific procedures and recommendations on postoperative device evaluation
- Specific procedures and recommendations on postoperative device evaluation (continued)
- Indications for interrogation before discharge or transfer from cardiac telemetry
- Treatment of pacemaker failure
- Treatment of pacemaker failure
Pacing after cardiopulmonary bypass
- Conduction abnormalities after bypass
- Placement of temporary epicardial leads
- Setting the paced rate after bypass
- Optimising the atrioventricular delay
- Choice of temporary pacing mode after bypass
- Choosing a temporary pacing mode
- Acute biventricular pacing after bypass
- Assessing ventricular dyssynchrony
Summary
- Key points on device identification
- Key points on intraoperative safety
- Key points on the postoperative period
- References
- References (continued)
- References (continued)
- Abbreviations used in this topic
- Abbreviations used in this topic (continued)
- Abbreviations used in this topic (continued)
- Abbreviations used in this topic (continued)
- Abbreviations used in this topic (continued)
- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition