Anesthetic Implications for Patients With Permanent Pacemakers

Abstract

Anesthesiologists will increasingly be required to treat patients with permanent pacemakers in the periopera tive period. Careful preoperative anesthetic evaluation is mandatory and includes attention to both the initial pathology that led to pacemaker insertion as well as to coexisting disease and treatment. Specific information regarding the patient's pacemaker should be sought, including the type and model, battery state, ability to stimulate the heart, and the expected response to placement of a magnet over the device. Additional preoperative considerations are discussed. Important intraoperative considerations for patients with perma nent pacemakers are also reviewed, including issues of rate-adaptive pacing, electrical interference with pace maker function, and loss of pacing capability. Additional intraoperative anesthetic issues, including the choice of anesthetic technique and the use of invasive monitoring for patients with permanent pacemakers are addressed. Specific considerations for lithotripsy, radiotherapy, and magnetic resonance imaging are also discussed. Finally, postoperative considerations are reviewed. Although pacemaker complications are unusual during anesthe sia, it is essential that anesthesiologists be able to anticipate, recognize, and treat pacemaker dysfunction in the perioperative period.