Implanted Devices

Three implanted items are of concern pre-operatively. The Beacon Hospital details regarding the management of cardiac devices listed below are available in ‘Temporary Device Programming During Surgical Procedures’ (Doc. No. PPC-ORG-921). This is available on Q-Pulse.

  1. Pacemakers (PPMs)

  2. Implantable cardioverter-defibrillators (ICDs)

  3. Spinal cord stimulators

PPMs / ICDs

  • Patients with a PPM or ICD attending for Pre-Operative Assessment should be brought to the attention of the Cardiology department.
  • If the patient has not had a device check within three months of the date of their procedure, a device check is indicated.
  • The staff in the Pre-Operative Assessment Clinic (POAC) should contact the Cardiac Physiologists to schedule a device check if required.
  • An attempt should be made to facilitate any patients with PPMs or ICDs first on the theatre list on the day of their procedure if that procedure has a requirement for deactivation of any functionality of the device.
  • In the above case, the PPM or ICD should be reprogrammed post-operatively.

Spinal cord stimulators

  • Multidisciplinary involvement is required to formulate a safe management plan for patients with an SCS1.

  • The responsible pain team should be contacted in order to provide advice and assistance as they have access to essential information regarding the device and its management.

  • The device should be interrogated and turned off before anaesthesia, to prevent inadvertent reprogramming or activation during surgery from electromagnetic interference.

  • Whilst active, the SCS may also interfere with ECG monitoring causing high-frequency artefacts.

  • The anaesthetist scheduled for the operating list that day should be informed of the presence of the device.

References

1.
Bull C, Baranidharan G. Spinal cord stimulators and implications for anaesthesia. BJA education. 2020;20(6):182-183. doi:10.1016/j.bjae.2020.02.005