Unintended ICD discharge in a patient undergoing bladder tumor resection utilizing monopolar cautery and full‐body return electrode

Lefevre, Ryan J.; Crossley, George H.; Sorabella, Laura; Siegrist, Kara K.; Eagle, Susan

doi:10.1111/jce.14699

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…Our case and the other cited cases indicate that the ASA Practice Advisory should consider additional factors other than the location of the surgery when monopolar electrocautery is utilized [3][4][5]. Our case is unique in that it illustrates that the recommendations of Singleton et al [3], including distance to the sensing electrode, patient height, and underbody dispersion electrode, may not be enough.…”

Section: Discussionmentioning

confidence: 70%

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Inappropriate Implantable Cardioverter-Defibrillator Therapy During Total Hip Arthroplasty

DeLeon¹,

Lu²,

Chen³

et al. 2023

Cureus

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Electromagnetic interference (EMI) is a known risk factor for triggering inappropriate therapy from implantable cardioverter-defibrillators (ICDs). Recommendations from the American Society of Anesthesiologists focus on EMI when using monopolar electrocautery for supraumbilical surgeries. Infraumbilical surgeries are not considered high risk for EMI; thus, no magnet must be applied routinely to prevent inappropriate ICD therapy intraoperatively. We describe a case of a 71-year-old woman who presented for left total hip arthroplasty with a history of an ICD. The patient's history was significant for non-ischemic cardiomyopathy. Monopolar electrocautery was used, and the level of the surgery was below the umbilicus. She experienced nine inappropriate ICD therapies intraoperatively with no long-term sequelae. The location of the electrocautery dispersion pad may have contributed to inappropriate therapies. Thus, the dispersion pad location should be considered when deciding whether to suspend anti-tachycardia functions intraoperatively. We present a case of inappropriate therapy from an ICD and make a recommendation for preventing such events.

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Section: Discussionmentioning

confidence: 70%

“…Other cases of underbody dispersion pads associated with inappropriate ICD therapy have been reported [ 4 , 5 ]. As proposed by Singleton et al [ 3 ], the current may have traveled close enough to the sensing electrode despite a far distance to the pacemaker generator.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate Implantable Cardioverter-Defibrillator Therapy During Total Hip Arthroplasty

DeLeon¹,

Lu²,

Chen³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…The level of EMI was considered to be high in the cardiac subjects, however the authors were unable to determine if use of the pad contributed to the EMI since they had no comparative control of a conventional adhesive electrode. Lefevre et al [14] observed ICD discharges when using electrosurgery during bladder surgery with the Mega Soft pad under the patient's torso. Tully et al [15] also observed ICD discharges when using electrosurgery during sacral debridement with the Mega Soft pad under the patient's torso.…”

Section: Use In Patients With Implantable Devicesmentioning

confidence: 99%

A Review of Capacitive Return Electrodes in Electrosurgery

Borgmeier¹,

Ricketts²,

Clymer³

et al. 2021

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Background: Monopolar electrosurgery, one of the most widely used techniques in surgery, requires two electrodes: a working electrode and a return electrode. Commonly, adhesive or "sticky" pads that attach directly to the patient are used as return electrodes. Acting as electrolytic conductors, adhesive pads are highly effective, but require some effort to apply and remove, and if improperly placed or partially detached may lead to high electrical current density and the potential for pad site burns. Alternatively, a capacitive return electrode, such as the Mega Soft pad, may be used that works on the same principle as a two-plate capacitor. Objective: This article details the technology underlying capacitive electrodes, reviews the scientific literature to-date, and provides recommendations on how to best use the Mega Soft pad. Results: No direct contact is required between the pad and patient, and the return electrode is designed so that current density is limited regardless of pad placement, reducing the risk of pad site burn. Although the technology is now mature, having been in the field for over 20 years, best practices for optimal performance from capacitive return electrodes are still not widespread, and misunderstandings persist regarding use of capacitive electrodes with contact monitoring systems and implantable electronic devices. Conclusion: With proper training, capacitive return electrodes may be substituted for conventional adhesive pads with the benefits of easier application and reduced risk of pad site burns.

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How Should We Prepare the Patient With a Pacemaker/Implantable Cardioverter-Defibrillator?

Schulman¹,

Stecker²

2023

Evidence-Based Practice of Anesthesiology

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Unintended ICD discharge in a patient undergoing bladder tumor resection utilizing monopolar cautery and full‐body return electrode

Cited by 7 publications

References 5 publications

Inappropriate Implantable Cardioverter-Defibrillator Therapy During Total Hip Arthroplasty

Inappropriate Implantable Cardioverter-Defibrillator Therapy During Total Hip Arthroplasty

A Review of Capacitive Return Electrodes in Electrosurgery

How Should We Prepare the Patient With a Pacemaker/Implantable Cardioverter-Defibrillator?

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