Is it safe to install a temporary pacemaker before surgery?
As an anesthesiologist, patients with cardiac pacing or conduction disorders are often encountered, and some of them require a pre-operative clinical cardiac pacemaker to prevent a sudden jump in the surgery center. However, is it really safe for patients to have a temporary pacemaker? Please see the case below.
[case introduction]
A 74-year-old woman, weighing 65 kg, was treated with "incomplete aphasia for 2 weeks, intermittent headache with tinnitus for 1 week", MRI found intracranial space, and a general anesthesia for craniotomy. No previous heart, chest tightness, syncope history, activity tolerance is acceptable. ECG and ECG Holter suggest "sinus bradycardia". Considering the patient's advanced age and bradycardia, a temporary cardiac pacemaker was installed on the morning of the operation (electrodes were placed in the right ventricular apex, pacing frequency was set to 60 bpm, voltage was 5 v).
The patient's blood pressure after entering the room was 130/70mmHg, HR 78bpm, and autonomous rhythm. Check the pacemaker function well before anesthesia. Induction medication: sufentanil 20ug, propofol 100mg (fractional), cis atracurium 13mg, tracheal intubation. Maintenance medication: sevoflurane 1.5%. At this time, the HR dropped to about 60 bpm, the NBP dropped to 70/40 mmHg, the infusion was immediately accelerated, and the infusion of dopamine was started at 5 ug/kg/min to establish an invasive blood pressure, but the circulation improvement was not obvious (HR 55-60 bpm, SBP <85 mmHg). . On the head frame, HR rose to 80 bpm, SBP swelled to 160 mmHg, given sufentanil 10 ug, and adjusted sevoflurane 2.0%. However, the cycle is still unstable, with HR <60bpm, SBP < 80mmHg; and HR > 60bpm, SBP > 140bpm, carefully comparing the ECG with the invasive artery waveform, the competent anesthesiologist believes that hypotension is associated with pacing rhythm. Therefore, the pacemaker's "pacing frequency" is set to 50bpm, the patient's autonomic rhythm is maintained, the blood pressure is quickly stabilized, and then dopamine is stopped. The patient's autonomic rhythm is maintained as much as possible throughout the operation, the circulation is very stable, and the operation is smooth.
However, the intraoperative phenomenon is of great interest to the competent anesthesiologist, and the pacing rhythm causes the patient to have low blood pressure! After searching the data, the doctor found that this was a phenomenon called "pacemaker syndrome." Below we will know what is the pacemaker syndrome.
The Laryngeal Mask Airway is the non-surgical and invasive device used for human body cavity in the short time, which is not in association with active medical devices. It can establish an artificial airway when the cuff of laryngeal mask tight covers the throat during the anesthesia and emergency treatment. It is also useful in situations where manipulation of the head or neck to facilitate endotracheal intubation is difficult or unsuccessful.
Speciality:
-Eliminates all possibility of infections being transmitted between patients
-Flexible optic fibre makes access easy
-Thanks to the semi-transparent tube, condensation is clearly visible
-Does not induce laryngeal spasms
-Reduces the risk of obstruction of the upper respiratory tracts
-Lesser incidences of hypoxia
Various laryngeal mask can be choosed in laryngeal mask intubation kit, such as pvc laryngeal mask, pvc reinforced laryngeal mask, silicone laryngeal mask, silicone reinforced laryngeal mask airway.
Anesthesia Laryngeal Mask Kits,Anesthesia First Aid Kit,Intubation Kit for Hospital,Surgical Laryngeal Mask Kit
Hangzhou Trifanz Medical Device Co., Ltd , https://www.cfzmed.com