Cardiac Pacemaker and Anesthesia

Park, Wook; Oh, Hung Kun

Abstract

Since the first successful use by Zoll (1952) of electrical stimulation through the chest wall to restart the arrested human heart, technical advances have made long-term electical stimulation of the heart effective in preventing recurrent Stokes-Adams syndromes and in treating the debilitating effects of low cardiac output in patients with heart block. This paper reviews experiences with anesthesia administered from Jan. 1968 through May 1975 to 17 patients who had cardiac pacemaker electrodes implanted, under general anesthesia in. 5 cases and local anesthesia in 12 cases. The 5 patients under light general anesthesia received respectively halothane in 2 cases, methoxyflurane in 1, ether in 1 and ketamine in one. No significant difference in morbidity and mortality was attributed to any of the anesthetics used. In 3 of the 5 cases under light general anesthesia, the implantation of permanent cardiac pacemakers was transvenously performed for complete heart block. The implantation of a temporary epicardial electrode in one of the 5 cases was performed because complete heart block had developed immediately after mitral valve replacement during cardiopulmonary bypass. Of the 5 cases under light general anesthesia, one. already had a transvenous pacemaker implanted permanently, and exploratory laparotamy was performed for repair of E-loop obstruction with recurrent stomach cancer. Of the 12 patients who had permanent cardiac pacemakers inserted transvenously under local anesthesia (1% procaine in 10 cases and 0.5% or 1% lidocaine in 2 cases), electrode malpositions appeared in 3 cases and infected electrodes in 3 cases respectively. There were no deaths during anesthesia and operation more important than the particular agent used were the precautions applied for control of cardiac action before and during anesthesia.

Cardiac Pacemaker and Anesthesia

Abstract

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