Anesthetic Management of Patients with Cardiac Pacemakers Undergoing Noncardiac Surgery

Abstract

Background: Patients with cardiac disease presenting for noncardiac surgery pose a considerable challenge to the anesthesiologists. With the availability of better medical facility and sophisticated diagnostic methods, many patients especially of the elderly age group, are detected to have electrophysiological disorders. Pacemakers are being used with greater frequency for both conduction and arrhythmia problems in such patients. Care of the pacemaker during surgery as well as understanding its anesthetic implications is crucial in the management of these patients. The perioperative management of patients with permanent pacemaker undergoing noncardiac surgery will be discussed in this essay. Aims: The purpose of this study is to highlight the normal electrophysiology of the heart, the indications of pacemaker insertion, its types and the anesthetic management of patients with cardiac pacemakers undergoing non cardiac surgery. Conclusion: The heart is endowed with a specialized system for generating rhythmical impulses to cause rhythmical contraction of the heart muscle and conducting these impulses rapidly throughout the heart. The structures that make up the conduction system are the sinoatrial node (SA node), the internodal atrial pathways, the atrioventricular node (AV node), the bundle of His and its branches and the purkinje system. Keywords: Anesthetic management, Cardiac pacemakers, Noncardiac surgery