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1.
A Delhumeau S Ronceray X Moreau C Cottineau M Cavellat 《Annales fran?aises d'anesthèsie et de rèanimation》1988,7(2):162-164
A case is reported of irreversible damage being caused to a permanent programmable pacemaker by electrocautery used in the epigastric region. The pacemaker was rapidly replaced, and the patient had no adverse effects of this accident. The use of monopolar electrocautery in patients who have one of the new generation of programmable pacemakers is very dangerous. Bipolar forceps can reduce the level of interference between electrocautery units and pacemaker electrodes. With programmable pacemakers, the generator instruction manual should be consulted before surgery, as placing a magnet on the generator may not necessarily convert it to the asynchronous mode. When the use of electrocautery is unavoidable, external cardiac pacing electrodes should be placed on the patient, with an external cardiac pacemaker ready. 相似文献
2.
P Werner B Charbit E Samain E Farah J Marty 《Annales fran?aises d'anesthèsie et de rèanimation》2001,20(8):716-719
We report an unusual electromagnetic interference induced by an argon electrocautery device during a left hepatectomy on a dual chamber pacemaker, implanted for sinus node dysfunction in 87-year-old patient. Argon electrocautery induced inhibition of atrial stimulation and occurrence of irregular ventricular triggered activity. Normal pacemaker function resumed after electrocautery interruption. This case illustrates the need to focus on cardiac rhythm when a new electrical device is used in a pacemaker patient. 相似文献
3.
Bales JG Colon J Ramadhyani U LeDoux E Bennett JT 《Journal of pediatric orthopedics. Part B》2007,16(1):19-22
Pediatric heart condition management may include a variety of implanted cardiac devices. Monopolar electrocautery (Bovie) produces significant electromagnetic interference to these devices. This interference can alter the function of a cardiac generator resulting in a variety of complications including impaired cardiac output and asystole. We report the case of a 16 plus 2-year-old girl who presented with idiopathic scoliosis and a past medical history significant for complete congenital heart block treated with a DDD*** pacemaker. During surgery, the use monopolar electrocautery caused the patient to develop asystole and loss of pulsatile blood pressure. Electrocautery was subsequently terminated, the patient then returned to a normal sinus rhythm and blood pressure normalized. 相似文献
4.
Temporary use of an eroded bipolar pacemaker system 总被引:1,自引:0,他引:1
Over a 2.5-year period, of 176 bipolar pacemaker procedures, six were complicated by erosion (incidence, 3.4%). One patient was treated whose pacemaker was inserted at another hospital. Time from insertion to presentation ranged from 5 to 23 months. When infection was present, Staphylococcus epidermidis was found to be the offending organism. We have used a staged method for managing this problem. Initially, the bipolar pulse generator was exteriorized and worn suspended around the neck while infection was controlled. A new pacemaker system (catheter and pulse generator) was inserted from the opposite side once infection was controlled. The main advantage of this type of approach is that the old pacing catheter and old bipolar generator can be used as an effective temporary pacing system, while the infection is being controlled thus eliminating the step of inserting a temporary pacing catheter after the eroded generator and catheter have been removed. A temporary pacing catheter is only safe and effective for a few days (perhaps up to a week), and this may not be sufficient time to be sure that infection is locally controlled. In addition, the patient can be ambulatory as the old permanent catheter is not likely to be dislodged easily as compared with a temporary catheter. Follow up ranging from 2 to 23 months has shown this to be an effective method for treating bipolar pacemaker erosion or infection in all instances without further infection or complication. 相似文献
5.
It has been suggested that children with third degree heart block require insertion of a temporary pacemaker prior to general anaesthesia. This recommendation needs to be reevaluated with the availability of noninvasive transcutaneous cardiac pacing. We undertook a retrospective ten-year chart review of anaesthesia in children with third degree heart block undergoing pacemaker insertion or revision. Forty-eight children with complete heart block underwent seventy anaesthetics of which fifty three were in children without pacemakers or with nonfunctioning pacemakers. One child had a temporary pacemaker placed preoperatively following asystole in the emergency room. In children who were not being paced, 60% had baseline heart rates less than 60 bpm. Complications seen in this study, including hypotension, would not have been prevented by temporary pacemaker placement. We conclude that there is no benefit to routine preoperative temporary pacing in children with third degree heart block. 相似文献
6.
41例心脏双束支阻滞围术期处理与文献回顾 总被引:1,自引:0,他引:1
目的 提高麻醉医生对手术患者心脏双束支传导阻滞的认识.方法 回顾我院近5年41例双束支传导阻滞患者围手术期处理情况,并复习双束支传导阻滞有关问题的研究进展.结果 40例双束支阻滞患者麻醉手术经过顺利,术中发生低血压和心动过缓时均对药物治疗有效;1例左前分支阻滞患者在二次手术麻醉时心电图证实发展为完全性左束支阻滞,最终抢救无效死亡.结论 术前无症状不伴有房室传导阻滞的慢性双束支阻滞患者不必常规安装临时起搏器,但准备适当的药物及临时起搏设备是必要的. 相似文献
7.
Reported herein is our experience with pacemaker implantation in a neonate with complete AV block and without other concomitant
cardiac anomalies. A male fetus exhibited an intrauterine heart rate of about 40 beats per minute on the electrocardiogram.
An emergency pacemaker implantation was attempted at birth by means of intravenous temporary pacing to relieve signs of congestive
heart failure. On the 28th day of life, a myocardial electrode was fixed on the right ventricular wall and the generator was
positioned on the left side of the subcutaneous abdominal wall. A technical device was designed by means of packing pacemaker
wire in a loop-forming fashion with a silastic sheet and was made in such a way as to adjust with growth of the patient. During
the 2 year follow-up period, this technique proved to be effective. Our experience also supports the contention that pacemaker
implantation in the newborn is feasible and beneficial in the treatment of congenital complete AV block. 相似文献
8.
Kakha Beselia Merab Nachkepia Kakhaber Gigilashvili Grigol Keshelava Giorgi Janashia Guram Imnadze 《General thoracic and cardiovascular surgery》2010,58(5):248-250
A 40-year-old man was emergently hospitalized because of high fever, a transient ischemic attack, and complete atrioventricular
block. The diagnosis was endocarditis, cyst of the interventricular septum (IVS), and complete atrioventricular block. A temporary
pacemaker was introduced, and the patient underwent surgery that included IVS cystectomy, ventricular septum plication, and
aortic valve replacement. A permanent pacemaker was implanted during the early postoperative period. The patient was discharged
from the medical center on day 9 after primary surgery. At the 4-month postoperative follow-up, the patient was found to be
in normal condition. Patients with high temperature, heart rhythm and conduction disorders, and dyspnea of unknown etiology
might be harboring Echinococcus despite the absence of primary liver or lung damage. Urgent surgical treatment is necessary even on suspicion of complicated
hydatid damage to the heart. 相似文献
9.
For last ten years twenty three cases of anesthesia were performed in twenty surgical patients with complete left bundle branch block (CLBBB) ranging in ages from 58 to 82 years. The CLBBB in these patients included 16 cases of permanent block, 6 cases of transient block and one case of alternative block. Two of these patients had no past history of heart disease, but the remaining patients had hypertension, ischemic heart disease, cardiomegaly, cardiac hypertrophy or others. Transient episodes of CLBBB were detected on the preoperative examination, on arrival at operating room or after the emergence from anesthesia at a recovery room, and some of which were provoked by elevated blood pressure or increased heart rate. A transient CLBBB in the patient changed to permanent CLBBB two years later. Complete atrioventricular (A-V) block appeared suddenly in the patient with alternative CLBBB four months after the surgery. Complete A-V block did not develop during anesthesia and surgery in our patients with CLBBB. Therefore we consider a routine prophylactic temporary pacemaker is not necessary during anesthesia and surgery in patients with asymptomatic CLBBB. However, a temporary pacemaker equipment should be at hand in case of complete A-V block. Appropriate perioperative management of circulatory system is important for the patients with CLBBB because most of these patients have underlying heart disease. 相似文献
10.
A case is presented which describes the initiation of atrialventricular (A-V) sequential pacing using atrial epicardial wires and an in situ transluminal ventricular pacing probe. A 68year-old female with a permanent A-V sequential pacemaker was scheduled for elective aortocoronary bypass. Following sternotomy, pacing function was converted to ventricular pacing (WI) with the use of electrocautery. A Chandler® V-pacing probe was introduced through a Paceport® (American Edwards) pulmonary artery catheter and with a paced increase in ventricular rate, the cardiac output increased from 2.8 to 3.2 L · min-1. At the conclusion of cardiopulmonary bypass the patient was in sinus rhythm at a rate of 67 · min-1 and was paced to a faster rate using bipolar atrial epicardial wires. The patient subsequently developed intermittent heart block so temporary A-V sequential pacing was established using atrial epicardial wires and the in situ ventricular pacing probe. Pacing was achieved at routine generator output settings of seven milliamps (mA) for both atrium and ventricle and at an A-V interval of 0.120 sec. This resulted in an immediate increase in cardiac output from 3.3 to 4.1L- min-1. The compatability of these two pacing systems offers an increased margin of safety in cardiac surgery patients requiring atrial pacing, who are at risk for developing postoperative heart block. 相似文献
11.
Electrocautery and pacemakers: management of the paced patient subject to electrocautery 总被引:6,自引:0,他引:6
P A Levine G J Balady H L Lazar P H Belott A J Roberts 《The Annals of thoracic surgery》1986,41(3):313-317
Electrocautery, commonly used during surgery to maintain hemostasis, can have significant detrimental effects in the paced patient. Damage to the pulse generator, reprogramming of the pacemaker, changes in the capture threshold, and ventricular fibrillation can all be induced by electrocautery. Familiarity with the particular pacemaker in use is critical in minimizing these adverse effects. Preoperative evaluation of the patient's dependence on the pacemaker and evaluation of pacemaker function should be performed and documented. We recommend close intraoperative monitoring of heart rate and rhythm, and suggest that a pacemaker programmer be on hand in the surgical suite during the operation. A postoperative check of pacemaker function should be carried out so that electrocautery-induced pacemaker malfunction will not go unnoticed or uncorrected. Three cases are presented which clearly illustrate these points. 相似文献
12.
Two White male patients with temporary complete heart block (CHB) secondary to hyperkalaemia are presented. One, a 40-year-old man, developed CHB with ensuing shock within the first 24 hours of repeat aortic valve replacement for a paraprosthetic leak caused by previous endocarditis. This patient experienced iatrogenic hyperkalaemia. The second was an 81-year-old man who had chronic renal failure and presented with Stokes-Adams attacks. This patient was initially thought to have degenerative CHB and nearly underwent inadvertent permanent pacemaker insertion. Both patients were initially treated with emergency temporary cardiac pacing with subsequent successful management. Temporary CHB secondary to hyperkalaemia, from whatever cause, has very rarely been documented in the literature. A review of this potentially lethal complication is undertaken and the significance of unifascicular and bifascicular conduction block as a consequence of hyperkalaemia is discussed. 相似文献
13.
Complete heart block in an adult with corrected transposition of the great arteries treated with permanent pacemaker. 下载免费PDF全文
A 53-year-old patient with corrected transposition of the great arteries developed complete heart block with fainting episodes. After temporary pacing through the endocardium of the venous (anatomically left) ventricle, a permanent epicardial pacemaker was implanted. This case shows the progressive nature of the atrioventricular conduction disturbances, which are very common in association with this congenital cardiac anomaly. 相似文献
14.
J P Caramella B Mentre F Jattiot R Strouk D Delétang 《Annales fran?aises d'anesthèsie et de rèanimation》1987,6(3):214-216
A case is reported of reprogramming of a ventricular unipolar permanent pacemaker induced by electrocautery during biliary surgery. After skin incision and use of the unipolar electrosurgery unit, the CPI model 505 multiprogrammable pulse generator previously set at 70 b X min-1 abruptly fired at 120 b X min-1. Application of a magnet over the pacemaker reduced the heart rate to 100 b X min-1. After surgery, the pulse generator was successfully reprogrammed to a rate of 65 b X min-1. Based on the analysis of this case and of previous reports, it is suggested, so as to avoid such complications, that the unipolar electrocautery be avoided when the surgical field is near the pulse generator or lead: that the bipolar electrocautery be preferred; that a magnet and non-invasive programmer be available during and after surgery; and that a postoperative assessment of the pulse generator be carried out. 相似文献
15.
The availability of external atrioventricular sequential pacemakers has improved the management of patients with sinus bradycardia, junctional rhythm, and atrioventricular block. However, these pacemakers are of less value in patients with postoperative heart block and accelerated atrial rhythms. The temporary use of a modified explanted dual-chamber demand pacemaker may counteract that problem by providing atrially triggered, P-wave-synchronous ventricular pacing. We report 2 patients in whom the temporary use of the dual-chamber demand pacemaker greatly facilitated weaning from cardiopulmonary bypass after coronary artery bypass grafting. 相似文献
16.
T. Strate C. Bloechle D. Broering A. Schuchert J. R. Izbicki X. Rogiers 《Surgical endoscopy》1999,13(7):727-727
In patients with implanted pacemaker/cardioverter defibrillator (ICD), the use of electrocautery can lead to serious pacemaker
dysfunction. The ultrasonically activated scalpel, however, which has been introduced mainly for the use in laparoscopic surgery,
could potentially avoid the outlined problem, since no electrical current flows while in use. This hypothesis was tested in
a pacemaker patient undergoing laparoscopic cholecystectomy. During the procedure, no abnormal rhythms or ECG interferences
were detected while working in close vicinity to the device. Thus, the ultrasonically activated scalpel provides adequate
hemostasis and does not bear the risk of pacemaker dysfunction.
Received: 12 January 1999/Accepted: 20 January 1999 相似文献
17.
《The Journal of arthroplasty》1998,13(5):599-602
Pacemaker dysfunction encountered during orthopedic procedures is a rare but potentially life-threatening complication. With an increasing number of orthopedic procedures performed on the aging population, it is not uncommon to encounter patients with pacemakers requiring major orthopedic intervention. Most, if not all, major orthopedic procedures performed today require the use of electrocautery for hemostasis. In this article we review the literature for pacemaker complications and report a case of pacemaker failure after a single use of the unipolar electrocautery on a patient undergoing a total hip replacement. 相似文献
18.
Pacemakers in children can present clinical challenges during surgery. We present a case report of an infant whose pacemaker reverted to a backup mode when electrocautery was used during surgery. The resulting bradycardia did not respond either to a magnet placed over the generator or to iv atropine. The circulation was supported by isoproterenol until the pacemaker was re-programmed by the manufacturer. Such devices require care and understanding if problems during surgery are to be avoided. 相似文献
19.
Shin Takabayashi Hisato Ito Hideto Shimpo Hirohumi Sawada Yoshihide Mitani Yoshihiro Komada 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2005,53(4):199-201
We report a case of an emergent pacemaker implantation in a 1,502 g preterm neonate immediately after birth due to congenital
complete atrioventricular block. At a gestational age of 29 weeks the patient was delivered by cesarean section followed by
unsuccessful drug treatment of the atrioventricular block. Sixty-five minutes after birth the patient underwent permanent
pacemaker implantation. Through a subxyphoid approach, a lead was fixed to the epicardium of the right ventricle, and connected
to a pulse generator inserted between the rectus abdominus muscle and posterior rectus sheath. The patient is alive and well
16 months after the operation without pacemaker failure. 相似文献
20.
Raghavendra Venkatesh Vikas Tandon Nishit Patel H.S. Chhabra 《Journal of Clinical Orthopaedics and Trauma》2015,6(4):259-264