title: Pediatric pacemakers and ICDs: how to optimize perioperative care.
abstract: An increasing number of pediatric patients with permanent pacemakers and implantable cardioverter defibrillators (ICDs) require cardiac and noncardiac surgery. It is critical that the anesthesiologist caring for these patients understands the management of the device and the underlying heart disease. Children with these devices are more vulnerable to lead failure and inappropriate shocks compared with the adult population. Preoperative assessment and appropriate reprogramming of the device, in addition to minimizing sources of electromagnetic interference, are keystones in the perioperative care of these patients. Prior consultation with qualified programmers is recommended to enable timely optimization of the device. Magnets may be used in emergency situations but it is important to appreciate the limitations of magnet use on different models of pacemakers and ICDs. Safe and successful perioperative care is dependent upon a well-organized and coordinated multidisciplinary team approach.
authors.affiliation: Department of Anesthesia, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA. manchuln@stanford.edu
authors.forename: Manchula
authors.initials: M
authors.lastname: Navaratnam
authors.forename: Anne
authors.initials: A
authors.lastname: Dubin
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D004574:Electromagnetic Fields; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care; D008280:Magnetics; D010138:Pacemaker, Artificial; D019990:Perioperative Care / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D019919:Prosthesis Implantation / Q000379:methods*