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Methods of Anesthesia II > Pacing and CIED's > Flashcards

Pacing and CIED's Flashcards

Lance Carter, AA-C

1
Q

Temporary Cardiac Pacing (4)

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2
Q

Transcutaneous Pacing

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3
Q

Disadvantages to Transcutaneous Pacing (3)

A
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4
Q

Placement Options for Transesophageal Pacing (2)

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5
Q

Advantages/disadvantages to Transesophageal Pacing (4)

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6
Q

Temporary Transvenous Placement (3)

A
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7
Q

Advantages (3) & Disadvantages (2) to
Temporary Transvenous Placement

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8
Q

Epicardial Pacing

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9
Q

Cardiovascular Implantable Electronic Devices (CIEDs)

A
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10
Q

Three types of CIEDs

A
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11
Q

Two primary reasons for a patient to receive a pacemaker (2)

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12
Q

Automated Implantable Cardioverter Defibrillators (AICDs) (2)

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13
Q

Biventricular pacemakers

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14
Q

Surgical Placement Of CIEDs

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15
Q

Capture Threshold

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16
Q

Normal Capture Ranges (Normal “Pacing Threshold”)

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17
Q

Maintenance & Sensitivity Threshold

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18
Q

Potential sources of heart beats in patient’s with pacemakers (2)

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19
Q

Demand Mode

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20
Q

Pacemaker “Sensing”

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21
Q

The Effect Of Cautery On Pacemakers

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22
Q

Pacemaker Dependent Patients

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23
Q

Asynchronous Mode

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24
Q

The Problem With Asynchronous Mode

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25
Q

The Advantage of Asynchronous Mode

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26
Q

Pacemakers should only be placed in asynchronous mode if (2)

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27
Q

Clinical Use Of Asynchronous Mode

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28
Q

Converting Pacemakers To Asynchronous Mode

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29
Q

How does rate modulation work?

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30
Q

Antitachycardia Pacing (ATP)

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31
Q

Indications For A Pacemaker (5)

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32
Q

What type of pacemaker should be used for this patient?

–Atrial? Ventricular? Or dual chamber (atrial + ventricular)?

A

Atrial

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33
Q

What type of pacemaker should be used for this patient?

–Atrial? Ventricular? Or dual chamber (atrial + ventricular)?

A

Ventricular

Because constant atrial activity would not allow the pacemaker to pace if it were only in atria

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34
Q
A

Single Chamber Pacemaker (in the Right Ventricle)

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35
Q

What type of pacemaker should be used for this patient?

–Atrial? Ventricular? Or dual chamber (atrial + ventricular)?

A

Dual-chamber

Complete AV block and atrial lead is used to “sense” atrial activity

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36
Q

Fixing Complete Heart Block With Pacing

A
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37
Q

Single Chamber Pacemaker for Complete Heart Block

A
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38
Q
A

Dual Chamber Pacemaker With A Normal ECG

Intrinsic rate is faster and SA/AV are working fine

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39
Q
A

Dual Chamber Pacemaker With Atrial Only Pacing

Patient has a slow SA node, but normal AVN conduction

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40
Q
A

Dual Chamber Pacemaker With Ventricular Only Pacing (Most common)

Normal SAN function, but complete heart block present

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41
Q
A

Dual Chamber Pacemaker With Dual Chamber Pacing

SAN/AVN both are non-functional (Sinus bradycardia and complete heart block present)

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42
Q

Biventricular Pacemaker

43
Q

Why Have An Additional Lead In The Left Ventricle? (2)

44
Q

Implantable Cardioverter Defibrillator (ICD)

45
Q

Traditional (Intravascular) ICD

47
Q

Advantages To The Subcutaneous ICD (S-ICD)

48
Q

Disadvantages To The Subcutaneous ICD (S-ICD) (3)

49
Q

ICDs In The Operating Room

50
Q

Preventing Accidental Shock From An ICD During Surgery (2)

A
  1. One way to prevent accidental shock from an ICD during surgery is to disable the shock function of the ICD
    –A pacemaker rep can do this by reprogramming the ICD prior to surgery, but the most common way we do this is to place a magnet over the ICD in the OR
  2. The second way to prevent accidental shock from an ICD during surgery is to keep electrical current (i.e. cautery) away from the ICD
    –One way to do this is to place the grounding plate as far away from the ICD as possible (at least 15cm)
    –The other way to do this is for the surgeon to use an alternative to unipolar cautery (like bipolar cautery or a harmonic scalpel)
51
Q

Advantages/disadvantages to a Harmonic Scalpel

52
Q

Magnet Application On ICDs

53
Q

Magnet Placement On An ICD

54
Q

Clinical Management Of ICDs (2)

55
Q
A

No shock. Bradycardia/possible asystole

  1. Put a magnet on
  2. Bipolar cautery or harmonic scapel
57
Q

How often should pacemakers and ICDs be checked?

58
Q

Preop Management of CIEDs

59
Q

What Anesthesia Should Know Preop (6)

A
  1. What type of device are we dealing with ? (pacemaker vs. ICD)
  2. What is the programmability of the device? (i.e., VOO, etc)
  3. What is the underlying rhythm? (why was the pacemaker placed?)
  4. Is the patient is pacemaker dependent?
  5. Does the pacemaker have rate modulation?
  6. Does the pacemaker capture effectively?
  7. What is the magnet response?
  8. Is there adequate battery life? (> 3-6 months)
  9. What are the manufacturer’s perioperative recommendations?
60
Q

Intraoperative Management

61
Q

Postop

62
Q

CIED Algorithm

63
Q
A

Yes she is pacemaker dependent.

  1. Call rep or put pacing pads on
  2. Bipolar cautery or harmonic scapel
  3. Transcutaneous pacing

Nothing, it will stop pacing and causing bradycardia or asystole

64
Q
A

No he is not pacemaker dependent

Magnet placement will convert the pacemaker into asynchronous mode and increase HR

No a magnet should not be placed on this patient

Zero effect of cautery on his heart rate

65
Q
A

Not required but dependent on the provider

Magnet placement would disable the shock function

66
Q
A

Magnet placement will disable shock function and will not change EKG and still in demand mode

Yes, a magnet should be placed

67
Q
A

Place magnet

68
Q
A

Rep needs to activate asynchronous mode

69
Q
A

Rate modulation was not disabled

70
Q

1st Letter In The Pacemaker Classification Code

71
Q

2nd Letter In The Pacemaker Classification Code

72
Q

3rd Letter In The Pacemaker Classification Code

73
Q

When The 3rd Letter Is “I”

74
Q

When The 3rd Letter Is “T”

75
Q

An Example Of Triggering

(When The 3rd Letter Is “T”)

76
Q

When The 3rd Letter Is “D”

77
Q

When The 3rd Letter Is “O”

78
Q

4th (Programmability) & 5th Letters

79
Q

AAI Pacing

80
Q

AOO Pacing

81
Q

VVI Pacing

82
Q

VOO Pacing

83
Q

DDD Pacing

84
Q

DOO Pacing

85
Q

VDD Pacing

86
Q

MRI & CT Scans

87
Q

Radiation Therapy

88
Q

RF Ablation, Emergency Defibrillation

89
Q

Transcutaneous Electrical Nerve Stimulation (TENS)

90
Q

TENS & CIEDs

91
Q

Electroconvulsive Therapy (ECT)

92
Q

Cardiovascular & Cerebral Effects of ECT

93
Q

Methohexital

94
Q

Etomidate

95
Q

Propofol

96
Q

Ketamine

97
Q

Airway Management For ECT

98
Q

Neuromuscular Blocking Agents For ECT

99
Q

CIED Implications For ECT (4)

100
Q

Extracorporeal Wave (ESW) Lithotripsy

101
Q

Synchronized Litho Shocks

102
Q

Non-Synchronized Litho Shocks

103
Q

CIEDs may interpret these the shocks the same way they interpret cautery. This could cause:

104
Q

How does synchronized litho shocks can cause arrhythmias in atrially paced patients?

Methods of Anesthesia II (15 decks)

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