Operation – Implantation of a pacemaker/defibrillator
Duration – 1-3 hours
Practical recommendations – M/a sedation. OA: ETT/mechanical ventilation or LM/SD.
- Implantable defibrillators are prescribed to patients at risk of sudden death due to malignant arrhythmias. Patients can range from young and otherwise healthy adults with normal myocardial contractility to extremely compromised cardiological patients.
- The procedure can be simple when two venous electrodes (sensitive and discharge) are inserted through a vein, or complex when a pacemaker is replaced or a coronary sinus is catheterized to gain access to the LV muscle.
- The procedure is expensive (£ 20 – electronic unit). In some departments, cardiologists create their own sedation service.
- During the procedure, ventricular fibrillation is induced several times to test the device. During this phase, the patient should be sedated.
- Invasive monitoring (arterial line) is desirable for any patient with reduced contractility.
- A cardiologist usually accesses through the lateral saphenous vein of the left hand (v. Cephalica) and uses fluoroscopy to determine the position of the electrodes.
- Careful adherence to aseptic rules is necessary to avoid infection of the implant. I/v antibiotics are usually prescribed.
- Consider the total dose of local anesthetic used by the cardiologist!
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- A thorough examination is required to evaluate the functional reserve of the heart. Use m/a and sedation in any patient with a compromised myocardium.
- Ensure the availability of all resuscitation facilities and equipment, as well as an external defibrillator (usually stick adhesive electrodes).
- Vasopressors and vagolitics (ephedrine/metaraminol/glycopyrrolate) are prepared. Make sure you have qualified assistance.
- A large diameter arterial line and venous cannula are established under mild sedation.
If sedation is used, give small doses of midazolam and fentanyl until a comfortable, contact, but sleepy state of the patient is achieved, then the propofol infusion in a controlled target concentration is connected. A dose of 0,5-1 μg/ml is established. It is necessary to achieve superficial sleep, in which the patient controls his own airways. Apply auxiliary oxygen therapy. Immediately before testing the defibrillator, sedation is deepened.
If OA is planned, make sure that the awakening is planned before surgery. Only superficial anesthesia is needed, caution is required during induction, since many of these patients have a limited cardiac reserve. The X-ray table may not be tilted, therefore, to conduct induction more reliably on a rotating gurney.
- During test fibrillation, if the device does not work, do not let the heart be stopped for a long time!
- After fibrillation and defibrillation, blood pressure may remain low for a short period. Vasopressors may be required.
- If the patient already has a pacemaker that needs to be replaced, and the cardiologist uses diathermy, the old pacemaker may fail completely.
- Do not let yourself be distracted by what is happening around.
- A large plastic protective shield (similar to that installed when working on the carotid artery) allows the anesthetist to control the patient’s airway without compromising sterility.
The effect of anesthesia on the heart
The effects of anesthesia on the heart can be different. Therefore, usually before anesthesia, the specialist always interviews the patient. People who initially suffer from heart diseases are invited to undergo a comprehensive diagnosis. Due to this, the general condition of the body is revealed and the most acceptable type of anesthetic is selected.
- rapid pulse;
- sensation of hot flashes in the body;
- unpleasant chest tightening;
- slow heartbeat.
In addition, the patient may experience stabbing sensations in the heart area that cause him real pain. Violation of cardiac activity most often develops after exposure to general anesthesia.
The effect of general anesthesia on the heart can be harmful and it manifests itself after a lot of time from the moment when medical interventions in the human body were performed. All activity of the nervous system begins to decline, brain cells can die, interruptions in breathing occur. The most sad and terrible consequence of the action of general anesthesia is coma. Falling into this state, a person may not wake up and die from cardiac arrest.
With inhalation anesthesia, cardiac arrhythmia or tachycardia can develop. In more rare cases, cardiac muscle arrest occurs. This can happen both during the operation and after it.
To protect your body from the possible development of undesirable consequences after anesthesia, this method of anesthesia should be taken seriously. It is necessary to consult with a doctor in detail on all points that cause concern. It is necessary to undergo a comprehensive examination and identify the preliminary reaction of the body to a particular anesthetic drug.