Anesthesia for Pacemaker Insertion

Abstract

In recent years, the nature of pacemaker implantation in the United States has changed dramatically, as ad vances continue in the technology of pacemakers and the techniques for insertion. Changes have also allowed for the expansion of indications for pacing to include cases in which it can serve as a therapeutic modality to alter hemodynamic states. Where once surgeons were primarily responsible for the procedure, the task now falls under the services of cardiologists. Insertions are commonly performed on an outpatient basis in the cardiac catherization suite. Local anesthesia is sufficient and, therefore, limits the need for anesthesiologists during pacemaker insertion. However, complicated, high-risk patients are now presented for pacemaker insertion. Furthermore, the 1998 American College of Cardiology/American Heart Association (ACC/AHA) guidelines include hypertrophic obstructive cardiomy opathy, dilated cardiomyopathy, and pacing after car diac transplantation as 3 new indications of particular interest. It is these conditions that enlist the expertise of anesthesiologists for monitoring, administering of anal gesics and sedatives, and resuscitation because of complications. This article provides a comprehensive description of common implantation procedures and the anesthesia used for pacemaker insertion. The focus is on the new 1998 ACC/AHA indications as well as general complications that invariably arise even during routine insertion. It is these areas that are of particular interest to anesthesiology as technology, technique, and indications for pacemaker insertion continue to evolve.