Cardiac Patients for Non-Cardiac Surgery: Anesthetic Considerations in Patients with Permanent Pacemaker

Abstract

Permanent pacemaker (PPM) are being used in greater frequency in managing patients with electrophysiology disorders. These patients can be presented for either cardiac or non-cardiac surgery after their device implantation. They also will undergo either general or regional anesthesia to facilitate the surgical procedure. As an anesthesiologist, understanding patients’ condition, pacemaker care and safe anesthetic technique of choice are very important to provide safe patient management. Therefore, this literature reviewed and summarized a systematic approach which can be followed in managing these patients.
 Various approach and guidelines have been discussed in the literature on how to manage patients with PPM who will undergo anesthesia. In this literature, the American Society of Anesthesiology (ASA) standard was used as a framework for managing patients with PPM. Meanwhile, the decision of anesthesia technique that being chosen should be based on patients’ clinical condition, the surgical procedure itself, the duration of surgery, and the convenience of the surgeon.
 Overall, patients with PPM require special attention in perioperative management. Both anticipations of the patient’s condition and the performance of PPM must always be considered to provide safe anesthesia practice.

Perioperative Management in Patients with Temporary Pacemaker Who Underwent Craniotomy in Prone Position

“…Another thing to avoid is the use of a harmonic scalpel because ultrasonic waves can cause mechanical damage to the pacemaker and cause ventricular extrasystole (VES). [1][2][3][4][5] In induction, this patient was given propofol and analgesic fentanyl at a dose of 2 mcg/kg BW with consideration not to use high doses of fentanyl and consideration the patient was already on continuous intravenous lidocaine therapy previously. This is consistent with the recommendation that in patients with a pacemaker and consequent bradycardia, the use of high doses of fentanyl and dexmedetomidine should be avoided because they may affect the threshold of pacemaker stimulation and increase the dependency of the heart on the pacemaker.…”