Pacemaker failure on induction of anaesthesia.
A patient with a permanent pacemaker presented for repair of a strangulated hernia. During induction of anaesthesia, the pacemaker generator stopped discharging, thus causing cardiac arrest. The likely cause of the generator failure was inhibition by suxamethonium-induced muscle fasciculations. Following defibrillation, and increase in stimulation threshold necessitated urgent insertion of a transvenous pacing system. It is suggested that, when suxamethonium is to be used in a patient with a permanent pacemaker, consideration should be given to reprogramming the pacemaker to asynchronous mode before induction of anaesthesia. If a patient with a pacemaker requires defibrillation, an acute increase in stimulation threshold may result and cause loss of capture. Rapid insertion of a transvenous pacing system may be necessary.
Finfer
S R
SR
Anaesthetic Department, Wycombe General Hospital, Buckinghamshire.
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects*; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D004868:Equipment Failure; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D010138:Pacemaker, Artificial; D013390:Succinylcholine / Q000009:adverse effects*
D013390:Succinylcholine