Question | Answer |
Indications for Pacer/AICD | persistent bradycardia not response to medication, AV block, Syncope, Sinus nodal dysfunction |
What 1st letter means in classification of Pacer? | Chamber paced |
What 2nd letter means in classification of Pacer? | Chamber sensed |
What 3rd letter means in classification of Pacer? | Response to sensing |
What 4th letter means in classification of Pacer? | Programmability |
What 5th letter means in classification of Pacer? | Anti-tachy function |
What mode of pacers are most common? | VVI and DDD DDD is the ultimate form of physiological pacing available today |
How to prevent lead displacement? | Avoid N2O because of the expansion of air trapped; if PA cath needed, use paceport swan |
What 5 potential effect of electromagnetic interference (electrocautery( on pacers? | 1. Inhibition of pacing 2. Reversion to asynchronous mode of pacing 3. Inappropriate reprogramming 4. Induction of A-fib/V-fib 5. Burns at lead-tissue interference |
What 5 anesthetic considerations for patient with pacer? | 1. Identify type of pacer 2. Ensure normal serum potassium 3. Increase EKG monitor's pacing detection to maximize visibility of pacer spikes 4. Possible A-line to assess pulsatile flow 5. Avoid Sux or defasiculate (may inhibit pacer function) |
Pacer may mask toxicity of antiarrhythmic drugs, electrolyte disorders, MI? | Yes |
Any post op considerations? | Yes, avoid shivering (inhibit pacer function) and have pacer interrogated and reprogramed. |
Special equipment required in OR? and Why? | Have MAGNET available! It converts a demand pacer to an asynchronous "fixed" pacing mode because pacing inhibited by electrocautery. |
Intraoperatively, what precautions should be executed? | 1. Ask surgeon to use bipolar cautery. 2. Place grounding pat as near to surgical field but as far from pacer as possible (>15 cms) 3. Ask surgeon to use only short bursts and lowest energy level possible. |
If cautery causes asystole, what should we do? | Have surgeon to stop bovie and place magnet over pacer. |
Any precaution if pacer placed in asynchronous mode? | Be aware of potential for v-fib (R on T phenomena) |
What 1st letter means in AICD? | Shock Chamber |
What 2nd letter means in AICD? | Antitachy Chamber |
What 3rd letter means in AICD? | Tachycardia Detection |
What 4th letter means in AICD? | Antibrady Pacing Chamber |
ICD-S means? | Shock only |
ICD-B means? | Shock + brady pacing |
ICD-T means? | Shock + brady pacing + tachycardia termination |
What are 4 effects of electromagnetic interference on AICD? | 1. Inappropriate countershocks (senses cautery as Vf) 2. Inappropriate overdrive pacing (senses cautery as VT or SVT) 3. Inappropriate suspension of arrhythmia detection 4. Permanent damage to pulse generator |
Can Amiodarone be continued with AICD? | Yes, but has potential complications when combined with anesthetic agents such as profound hypotension, bradycardia. |
What function should remain active even with magnet in place? | Antibrady function |
What insertion sites be used for transvenous pacemaker? | Right internal Jugular area, left subclavian and femoral vein |