Navaratnam Manchula, Dubin Anne
Department of Anesthesia, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
Paediatr Anaesth. 2011 May;21(5):512-21. doi: 10.1111/j.1460-9592.2011.03562.x.
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.
越来越多植入永久性起搏器和植入式心脏复律除颤器（ICD）的儿科患者需要进行心脏和非心脏手术。至关重要的是，负责照料这些患者的麻醉医生要了解该设备的管理以及潜在的心脏病情况。与成年人群相比，装有这些设备的儿童更容易出现导线故障和不适当的电击。除了尽量减少电磁干扰源外，术前对设备进行评估并进行适当的重新编程，是这些患者围手术期护理的关键。建议事先与合格的编程人员进行会诊，以便及时对设备进行优化。在紧急情况下可使用磁铁，但重要的是要了解不同型号起搏器和ICD使用磁铁的局限性。安全且成功的围手术期护理依赖于组织有序且协调一致的多学科团队方法。
