Implications of a permanent cardiac pacemaker in peripheral nerve blockade.
Patients with permanent cardiac pacemakers (PPMs) are vulnerable to electromagnetic interference from electrical equipment used in the operating room environment. Electromagnetic interference may lead to PPM malfunction with potential harmful effects to the patient. Conventional techniques for peripheral nerve blockade include the use of electrical nerve stimulation (NS) for nerve localization. The hazards of NS, especially when applied near the implanted PPM sites, are not known. In the absence of available guidelines regarding the safe use of NS in the setting of an implanted PPM, we recommend a combined guidance approach for peripheral nerve blockade using ultrasound for nerve localization along with low-current NS for nerve identification.
Manickam
Baskar P
BP
Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Ontario, Canada.
Brull
Richard
R
D004558:Electric Stimulation / Q000009:adverse effects*; D004574:Electromagnetic Fields; D004868:Equipment Failure; D004869:Equipment Safety; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D010138:Pacemaker, Artificial; D018579:Patient Selection; D010525:Peripheral Nerves / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D018084:Ultrasonography, Interventional