Pacemaker Insertion

Approach - Light sedation (fentanyl + versed) is typically all that is required for a pacemaker insertion. In some cases the surgeon can complete the case with only localization at the insertion site. Airway fire risk - Consider using face mask, blended O2, suction near the oxygen, or leaving at room air. Monitor the heart - These patients are at a high risk for cardiac arrhythmias. Keep a close eye on the ECG. ETCO2 - End tidal CO2 monitoring is required as the patient may be positioned out of your reach with their head covered by surgical drapes. Oxygen provided by nasal cannula or simple face mask is typically sufficient. Leads - Position the leads out of the way. Usually the black lead will go on the shoulder, and you can position the red lead perhaps a little lower.

Patients who require a pacemaker are already at risk for cardiac arrhythmias (bradycardia, ventricular tachycardia, ventricular fibrillation), the anesthesia provider should always be prepared for the treatment of any arrhythmia, keep Atropine, Epinephrine, Lidocaine, and vasopressors available. These patients also typically have multiple comorbidities (obesity, diabetes, vascular disease, lung disease).

Positioning for a pacemaker insertion requires the patient to lay flat on a hard surface. Many patients will be highly uncomfortable and may require more sedation and/or pain medication.