Anaesthetic consideration in patients with cardiac implantable electronic devices scheduled for surgery

Chakravarthy, Murali; Prabhakumar, Dattatreya; George, Antony

doi:10.4103/ija.ija_346_17

Cited by 18 publications

(30 citation statements)

References 49 publications

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“…In the present case, VOO mode was selected to avoid electromagnetic interference due to the proximity of the generator to the surgical site. DDD mode is widely used intraoperatively if the surgical site is not close to the generator [8] and considered to be superior to VOO as it maintains the "atrial kick" and sequential atrioventricular contraction [9]. If DDD mode is selected, caution should be exercised because muscle twitching can be induced by atrial pacing as occurred in this case.…”

Section: Discussionmentioning

confidence: 99%

Sudden onset pacemaker-induced diaphragmatic twitching during general anesthesia

et al. 2019

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Background: Involuntary muscle contraction caused by extracardiac stimulation is a rare complication induced by a pacemaker. We report a case who developed sudden onset diaphragmatic contractions during general anesthesia caused by a DDD mode pacemaker. Case presentation: A 74-year-old woman with a permanent pacemaker was scheduled to undergo mastectomy. The pacing mode was switched from DDD to VOO intraoperatively to avoid electromagnetic interference. Immediately after returning the pacing mode to DDD after surgery, diaphragmatic contractions occurred, mimicking bucking type of movements. After switching the pacing to A-sense V-pace, the twitching ceased. Because no structural problems were noted, and the twitching disappeared after terminating atrial pacing, diaphragmatic contractions might be caused by stimulation of the right phrenic nerve located near the right appendage where the electrode was installed. Conclusion: The potential risk of muscle twitching should be carefully evaluated preoperatively especially in patients with atypical position of pacemaker leads.

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Section: Discussionmentioning

confidence: 99%

Sudden onset pacemaker-induced diaphragmatic twitching during general anesthesia

et al. 2019

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“…25 With automatic implantable cardioverter defibrillator (AICD): Device should be reprogrammed, and antitachyarrhythmia functions should be disabled. 26 External defibrillator, temporary pacemaker, and full-resuscitation equipment should be ready. Adequate grounding, continuous ECG (in diagnostic mode), and pulse plethysmography should be present.…”

Section: Specific Cardiac Pathologiesmentioning

confidence: 99%

Challenges during Electroconvulsive Therapy—A Review

Bansal

Surve

Dayananda

2021

J Neuroanaesth Crit Care

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Electroconvulsive therapy (ECT) is one of the most successful treatment techniques employed in psychiatric practice. ECT is usually administered as a last resort to a patient who fails to respond to medical management or on an urgent basis as a life-saving procedure when immediate response is desired. It is performed under general anesthesia and is often associated with autonomic changes. All attempts should be made to minimize the resulting hemodynamic disturbances in all the patients using various pharmacological methods. Anesthesiologists providing anesthesia for ECT frequently encounter patients with diverse risk factors. Concurrent cardiovascular, neurological, respiratory, and endocrine disorders may require modification of anesthetic technique. It is ideal to optimize patients before ECT. In this review, the authors discuss the optimization, management, and modification of anesthesia care for patients with various cardiac, neurological, respiratory, and endocrine disorders presenting for ECT to improve the safety of the procedure. It is not infrequent that an anesthesiologist also plays an important role in inducing a seizure. Proconvulsants such as caffeine, adjuvants like opioids, hyperventilation, and appropriate choice of anesthetic agent for induction such as etomidate or ketamine can help. The use of BIS monitoring to guide the timing of electric stimulation is also elaborated in this review.

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“…[ 3 4 ] Therefore, irrespective of their scope of practice, anesthesiologists ought to anticipate managing patients with such devices undergoing cardiac and noncardiac surgical procedures, in fact some authors have advocated for an “ anesthesiology device service ” for the perioperative care of patients with CIED. [ 3 4 5 6 7 8 9 10 ]…”

Section: Introductionmentioning

confidence: 99%

Analyzing the Impact of Preoperative Interrogation of Cardiac Implantable Electronic Devices

Navas-Blanco

Williams

Modak

2021

Annals of Cardiac Anaesthesia

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Background: Cardiac implantable electronic devices (CIED) are becoming more common for the management of underlying of cardiac dysrhythmias, and more patients with these devices are presenting for cardiac and noncardiac procedures. Methods: We performed a retrospective, cohort, single-center study at a tertiary teaching medical center, gathering 151 patients with CIED undergoing elective and emergent surgeries for the time period between November 2013 and December 2016. We aimed to determine whether patients with CIED had the device interrogated before surgery as recommended by the Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) consensus, whether this lack of compliance led to delay in the holding area before surgery and determine the presence of intra- or postoperative cardiac events in these patients. Results: A total of 76% of patients had interrogation of the device before surgery. Emergent cases were not interrogated as much as elective cases preoperatively (43% vs. 18%, respectively; P < 0.05). In total, 6% of cases had a CIED-related average holding area delay time of 54 minutes. Patients without preoperative device interrogation had more perioperative cardiac events than those who had the device checked (25% vs. 8%, respectively; odds ratio [OR] 0.26; 95% CI, 0.09–0.7, P < 0.013). Conclusions: Our findings suggest that preoperative interrogation of the device plays a significant role to minimize the incidence of perioperative cardiac adverse events. Institutional providers show a lack of compliance with HRS/ASA recommendations for preoperative CIED management. Further research is required to determine if improved compliance to recommendations will lead to enhanced outcomes.

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Anaesthetic consideration in patients with cardiac implantable electronic devices scheduled for surgery

Cited by 18 publications

References 49 publications

Sudden onset pacemaker-induced diaphragmatic twitching during general anesthesia

Sudden onset pacemaker-induced diaphragmatic twitching during general anesthesia

Challenges during Electroconvulsive Therapy—A Review

Analyzing the Impact of Preoperative Interrogation of Cardiac Implantable Electronic Devices

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