Finfer S R
Anaesthetic Department, Wycombe General Hospital, Buckinghamshire.
Br J Anaesth. 1991 Apr;66(4):509-12. doi: 10.1093/bja/66.4.509.
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.
一名植入永久性起搏器的患者因绞窄性疝修补术前来就诊。在麻醉诱导期间，起搏器发生器停止放电，从而导致心脏骤停。发生器故障的可能原因是琥珀胆碱诱导的肌肉颤动产生的抑制作用。除颤后，刺激阈值升高，需要紧急插入经静脉起搏系统。建议在给植入永久性起搏器的患者使用琥珀胆碱时，应在麻醉诱导前考虑将起搏器重新编程为非同步模式。如果起搏器患者需要除颤，可能会导致刺激阈值急性升高并导致夺获失败。可能需要迅速插入经静脉起搏系统。
