الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Special attention should be paid to patients with pacemakers during
anaesthetic management. Because of the growing numbers of patients with
these devices, the anaesthesiologest should be aware of some basic
information regarding, pacemaker, and the special anaesthetic management
for patients with such devices.
Artificial pacemaker is a medical device which uses electrical impulses
delivered by electrodes contacting the heart muscle to regulate the beating of
the heart. The primary purpose of a pacemaker is to maintain an adequate
heart rate, either because the heart’s native pacemaker is not fast enough, or
there is a block in the heart’s electrical conduction system.
Patients with implanted pacemakers can be managed safely for surgery and
other non-surgical procedures.
It requires thorough understanding about
indication of pacemaker insertion, various modes of pacing, and
programming of pacemaker.
A cardiologist should also be consulted for device evaluation regarding its proper function and life of the batteries.
Anaesthetic management should be planned preoperatively according to
patient’s medical status. Careful monitoring of ECG, pulse oximetry and
arterial blood pressure should be done. While using electocautery, precaution for minimal EMI should be taken. Magnet should not be placed over pacemaker in the OT in presence of electocautery. Rate responsive pacemakers should have rate responsive mode disabled before surgery.
Provision of temporary pacing should be available in the OT to deal with
emergency situation of pacemaker malfunction. Pacemaker should be
rechecked after the procedure.
So, the anaesthesiologest should be aware of some basic information
include:Anatomy of the heart including chambers, blood supply, nerve supply and
the conducting system of the heart.
Physiology of the heart and conducting system including The normal
pathway of the electric impulse initiated in the sinoatrial (SA) node “normal pacemaker” of the heart.
Pathophysiology of the cardiac conducting system especially cardiac
arrhythmias due to Abnormal impulse conduction “block and reentry”.
Either bradyarrhythimas when the propagating impulses are blocked and
followed by asystole or a slow escape rhythm, or tachyarrhythmias when the
impulse delay or block produce reentrant excitation.