El-Gamal H M, Dufresne R G, Saddler K
Department of Dermatology, Brown University School of Medicine, 593 Eddy Street, APC-10, Providence, RI 02903, USA.
Dermatol Surg. 2001 Apr;27(4):385-90. doi: 10.1046/j.1524-4725.2001.00287.x.
Minimal information is available in the literature regarding the precautions implemented or complications experienced by cutaneous surgeons when electrosurgery is used in patients with pacemakers or implantable cardioverter-defibrillators (ICDs). The literature pertinent to dermatologists is primarily based on experiences of other surgical specialties and a generally recommended thorough perioperative evaluation.
To determine what precautions are currently taken by cutaneous surgeons in patients with pacemakers or ICDs, and what types of complications have occurred due to electrosurgery in a dermatologic setting.
In the winter of 2000, a survey was mailed to 419 U.S.-based members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology (ACMMSCO).
A total of 166 (40%) surveys were returned. Routine precautions included utilizing short bursts of less than 5 seconds (71%), use of minimal power (61%), and avoiding use around the pacemaker or ICD (57%). The types of interference reported were skipped beats (eight patients), reprogramming of a pacemaker (six patients), firing of an ICD (four patients), asystole (three patients), bradycardia (two patients), depleted battery life of a pacemaker (one patient), and an unspecified tachyarrhythmia (one patient). Overall there was a low rate of complications (0.8 cases/100 years of surgical practice), with no reported significant morbidity or mortality. Bipolar forceps were utilized by 19% of respondents and were not associated with any incidences of interference.
Significant interference to pacemakers or ICDs rarely results from office-based electrosurgery. No clear community practice standards regarding precautions was evident from this survey. The use of bipolar forceps or true electrocautery are the better options when electrosurgey is required. These two modalities may necessitate fewer perioperative precautions than generally recommended, without compromising patient safety.
关于皮肤外科医生在为有起搏器或植入式心脏复律除颤器（ICD）的患者使用电外科手术时所采取的预防措施或所经历的并发症，文献中提供的信息极少。与皮肤科医生相关的文献主要基于其他外科专业的经验以及通常建议的全面围手术期评估。
确定皮肤外科医生目前对有起搏器或ICD的患者采取了哪些预防措施，以及在皮肤科环境中因电外科手术发生了哪些类型的并发症。
2000年冬季，向419名美国莫氏显微外科和皮肤肿瘤学学会（ACMMSCO）会员邮寄了一份调查问卷。
共回收166份（40%）调查问卷。常规预防措施包括使用少于5秒的短脉冲（71%）、使用最小功率（61%）以及避免在起搏器或ICD周围使用（57%）。报告的干扰类型包括早搏（8例患者）、起搏器重新编程（6例患者）、ICD放电（4例患者）、心搏停止（3例患者）、心动过缓（2例患者）、起搏器电池寿命耗尽（1例患者）以及未明确的快速性心律失常（1例患者）。总体并发症发生率较低（每100年手术实践0.8例），未报告有显著的发病率或死亡率。19%的受访者使用了双极镊子，且未发生任何干扰事件。
门诊电外科手术极少对起搏器或ICD造成显著干扰。本次调查未发现关于预防措施的明确社区实践标准。在需要进行电外科手术时，使用双极镊子或真正的电灼术是更好的选择。这两种方式可能比通常建议的需要更少的围手术期预防措施，同时不影响患者安全。
