Anaesthesia for the patient with pacemaker

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Anaesthesia for the patient with pacemaker

• Case presentation
• B Albinska

2
PATIENT MEDICAL HISTORY

• 74 y old lady
• IHD, MI 2001,
• Angina on exertion
• Good tolerance of walking on the ground level
• Recurrent AF
• Dual chamber pacemaker
• Hypothyroidism
• 1988 GA followed by fast AF

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Medication

• Warfarin
• Amiodaron
• Ramipril
• Simvastatin
• Thyroxine
• Diazepam
• GTN last use 6/12 ago
• Previously on B-blockers and Ca channel blockers

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Investigations

• Angiogram - normal coronary artheries
• Echo EF 50-60, septal apex dyskinesis, mild
  regurgitation of aortic mitral valves, no
  enlargement of any chamber
• ECG widened QRS complexes with occasional
  pacing
• Pacemaker checked 6 month ago

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Blood tests

• HB 13.5
• WCC 7
• Platelets 304
• Na 138
• K 4.2
• U 6.7
• Crea 146
• INR 2.6

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Present Medical History

• Left eye tumour for urgent biopsy

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Action plan

• Patient was assessed before operation
• Warfarin stopped for 3 days
• Admission the day before operation
• LMWH started on admission
• If cautery during operation only bipolar
• Check pacemaker before discharge

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Pre-op assessment on the day of operation

• Patient in optimal condition
• ECG no differences comparing to the previous
• INR 2.1
• Anxiety

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Anaesthesia

• Patient arrived to theatre
• ECG tachycardia 130/ min
• Induction Fentanyl, Propofol, antyemetic GA/LMA
• Rhythm slowed down, pacemaker started pacing
• Spontaneous ventilation
• Stable during operation
• Cautery not used
• Fully awake in recovery room

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Post op

• Patient discharged in the evening
• Pacemaker not checked because of unavailability
  of technician on Friday evening