PACEMAKERS
Preop Assessment, Ascertain:
Date of implant and reason,with underlying rhythm.
Type of pacemaker.
Battery longevity.
Date of last check and any concerns.
Programmed settings and magnet rate. (Physiologist to advise on any reprogramming for procedure)
Intraoperative
Identify pacemaker at sign in and time out.
Magnet, transcutaneous pads and defibrillator in theatre.
Bipolar preferable. Monopolar in 5 second burst with pad below the umbillicus, away from PM if required.
Use lowest possible energy for diathermy.
If PM inhibition occurs, halt electrocautery. Condsider magnet for asynchrous pacing.
Postoperative
If uneventful surgery, PM review may not be required post op. If in doubt, discuss with physiologist or anaesthetist.
Emergency surgery
Surgery should ideally be delayed until above pre and intraoperative advice can be followed.
If unable to delay, proceed with defibrillator attached and the above intraoperative advice. Anesthetist to apply magnet if appropriate.
High voltage cardioversion and defibrillation could cause permanent damage, activation of back up modes or loss of capture post cardioversion. Risk is reduced by use of AP pads away from the device.