Pacemakers and defibrillators: anaesthetic implications

Salukhe, Tushar V.; Dob, D.P.; Sutton, Richard

doi:10.1093/bja/aeh170

Cited by 57 publications

(28 citation statements)

References 49 publications

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“…Prinzipiell kann es durch Hochfrequenzchirurgie zu Hemmung und/oder Triggerung des SM-Systems, aber auch zu Änderungen des Stimulationsmodus kommen [8,9,19,24,26,50,56,60,65,70,74,84,90,100,103,105]. Eine kontinuierliche Anwendung verursacht normalerweise ein Umschalten des SM in den asynchronen "noise interference mode", während intermittierendes Kautern zu jeweils vorüberge-hender Hemmung führen kann und ungünstigstenfalls längere Pausen bis hin zur Asystolie möglich sind [86].…”

Section: Quellen Elektromagnetischer Interferenzunclassified

Perioperative management of patients with implanted pacemakers or cardioverter/defibrillators

Gombotz

Monti²,

Leitgeb³

et al. 2009

Anaesthesist

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The perioperative risk for patients with pacemakers or implanted cardioverter/defibrillators (ICD) is mainly dependent on the underlying disease. However, severe to life-threatening complications of the implanted system can occur due to electromagnetic interference in the environment of the operation. These complications can be prevented or adequately treated by taking special precautions and measures. Even though the currently available data on the optimal perioperative management to pacemakers and ICDs is still unsatisfactory, the increasing clinical relevance of this topic was the reason for the formulation of recommendations by an interdisciplinary working group in Austria.

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Section: Quellen Elektromagnetischer Interferenzunclassified

Perioperative management of patients with implanted pacemakers or cardioverter/defibrillators

Gombotz

Monti²,

Leitgeb³

et al. 2009

Anaesthesist

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“…To decrease the risk of cardiac events throughout pregnancy 18 pregnant women with LQTS should take their cardiac medications throughout the perinatal period, including labour and delivery. 2,15 Women with a cardiac pacemaker or ICD should have a review of the type and nature of the device 19 and this should be recorded on the antenatal chart. The effect of a magnet on the ICD should also be noted, whether the magnet will deactivate the defibrillator function, and whether the ICD program will be altered once the magnet is removed.…”

Section: 12mentioning

confidence: 99%

“…The effect of a magnet on the ICD should also be noted, whether the magnet will deactivate the defibrillator function, and whether the ICD program will be altered once the magnet is removed. 19,20 An ECG can be used to assess the frequency of paced beats. 2 Beta blockers are the mainstay of drug therapy in patients with LQTS with the exception of LQT3.…”

Section: 12mentioning

confidence: 99%

“…If this is not possible the pacemaker or ICD may need to be reprogrammed to an asynchronous pacing mode prior to surgery. 19 External defibrillation is possible in patients with ICDs, and those patients at very high risk for torsades should have external defibrillator pads applied before deactivating the ICD function. Postoperatively, the ICD should be reactivated.…”

Section: General Principlesmentioning

confidence: 99%

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Brief review: Anesthetic implications of long QT syndrome in pregnancy

Drake

Preston

Douglas

2007

Can J Anesth/J Can Anesth

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Purpose:To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS. Principal findings:The prevalence of LQTS in the developed world is one per 1,100 to 3,000 of the population. Clinically, LQTS is characterized by syncope, cardiac arrest and occasionally, by a history of seizures. The QT interval can also be prolonged by drugs, electrolyte imbalances, toxins and certain medical conditions. Long QT syndrome patients are at risk of torsades de pointes and ventricular fibrillation. Medical management aims to reduce dysrhythmia frequency. The LQTS is subdivided into different groups (LQT1-6) depending on the cardiac ion channel abnormality. Torsades can be precipitated by adrenergic stimuli such as stress or pain (LQT1 and 2), sudden noises (LQT2) or whilst sleeping (LQT3). Patients with LQTS require careful anesthetic management as they are at high risk of torsades perioperatively despite minimal data on the effects of anesthetic agents on the QT interval. While information on effects of LQTS in pregnancy is limited, the incidence of dysrhythmia increases postpartum. Isolated case reports of patients with LQTS women highlight several peripartum dysrhythmias.Conclusion: An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS.

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“…Tab. 4 soll einen Anhalt über mögliche Probleme geben, die eine Rücksprache mit dem Radiologen und/oder der Herstellerfirma über die MRT-Kompatibilität erfordern kön-nen[9,10].Herzschrittmacher und implantierte Defibrillatoren ("automatic implantable cardioverter defibrillator", AICD) sowie Cochlearimplantate sind Kontraindikation für eine Untersuchung im MRT[13]. Hier kann es zu dauernden Funktionsstö-rungen und Myokardschäden durch Erhitzung der Elektroden kommen.Derzeit werden aber im Rahmen von wissenschaftlichen Studien MRT-taugliche Schrittmacher getestet -eine Zulassung nach MPG ist bisher jedoch noch nicht erfolgt.Stents, Coils, Gefäßfilter, Aneurysmaclips und künstliche Herzklappen gelten als sicher, sofern sie aus nichtferromagnetischem Material bestehen.…”

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Pitfalls in magnetic resonance imaging

et al. 2007

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The constantly extending indication spectrum of magnetic resonance imaging (MRI) is a challenge for the anaesthesiologist, who is being increasingly more consulted for assistance during the examination. Due to the special technology of MRI the anaesthetic technique differs substantially from that in the operating theatre. In addition to the permanent strong magnetic field the intermittently used high frequency impulses are also a potential danger for the patient. Patients with metal implants (e.g. cardiac pacemaker) are particularly at risk. For the safe treatment of patients during MRI a special MRI compatible anaesthesia equipment is necessary. Unsuitable devices can lead to malfunctioning or to projectile effects (attracting ferromagnetic objects into the magnet) causing injury to the patients. This paper describes the MRI technology and the associated dangers for the patient as well as the characteristics of the anaesthetic techniques.

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Pacemakers and defibrillators: anaesthetic implications

Cited by 57 publications

References 49 publications

Perioperative management of patients with implanted pacemakers or cardioverter/defibrillators

Perioperative management of patients with implanted pacemakers or cardioverter/defibrillators

Brief review: Anesthetic implications of long QT syndrome in pregnancy

Pitfalls in magnetic resonance imaging

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