A modified algorithm for choosing the most appropriate intraoperative pacemaker mode for patients with permanent pacemak
- PDF / 834,223 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 18 Downloads / 167 Views
CLINICAL REPORT
A modified algorithm for choosing the most appropriate intraoperative pacemaker mode for patients with permanent pacemaker in non‑cardiac surgery Yusaku Terada1 · Tetsuya Miyashita1 · Yusuke Nagamine1 · Takahisa Goto1 Received: 22 May 2020 / Accepted: 7 November 2020 © Japanese Society of Anesthesiologists 2020
Abstract To avoid the risk of R-on-T incident and the unnecessary decrease of cardiac output, we devised an algorithm consisting of six steps for choosing the most appropriate intraoperative pacemaker (PM) mode, which is modified from Heart Rhythm Society and the American Society of Anesthesiologists expert consensus statement. Following this algorithm, we reviewed previous operations at our hospital to evaluate the appropriateness of the choices. Six of 78 cases (7.7%) were unfit to the algorithm because of an inappropriate mode change. The PM mode was changed preoperatively in four patients, even though the surgical site was under the umbilicus. In one case of the two other cases, the PM mode was changed from AAI to VOO. This case could not be avoided by the previous algorithm of the expert clinical statements. In another case, the anesthesiologist did not change PM mode even though the patient underwent parotidectomy and his heart rate depended on PM. Prospective research on this algorithm could clarify its usefulness in the future. Moreover, discussions about this algorithm could help develop this field of study and improve the intraoperative management of PMs. Keywords Algorithm · Pacemaker mode · Noncardiac surgery
Background The number of patients with permanent pacemakers (PMs) has increased, and anesthesiologists often experience patients with permanent PMs who are preparing to undergo an operation. Before the operation begins, anesthesiologists have to decide whether to change the PM mode. PMs can over-sense electromagnetic interference (EMI) and stop pacing, leading to critical bradycardia or cardiac arrest. On the other hand, if there is pacing without sensing (such as in VOO), ventricular fibrillation (VF) may occur when the patient’s heartbeat appears [1, 2]. For these reasons, an inappropriate choice of PM mode can lead to severe complications. Although both the Heart Rhythm Society and the American Society of Anesthesiologists provided expert consensus * Tetsuya Miyashita [email protected] 1
statement about the intraoperative management for patients with permanent PMs, no description is given regarding how anesthesiologists should choose the most appropriate mode during the operative period [3]. For example, there is a state “Rendering a PM asynchronous in a PM-dependent patient is preferable for most procedures above the umbilicus”, but it is not appropriate; there remains the possibility of R-on-T if his/her own heartbeat appears. We made a hypothesis that if we make new pacemaker algorithm, we can reduce some patients’ intraoperative risks.
Methods This study was approved by the Ethics Committee of Yokohama City University (IRB Approved No. 2018100). I
Data Loading...
