Baller M R, Kirsner K M
AANA J. 1995 Jun;63(3):209-16.
Pacemakers and the underlying pathophysiologies leading to their implantation present challenges to the anesthetist. This case report discusses the anesthetic management of a patient with an implanted pacemaker. A case is presented of an 80-year-old female who was found unresponsive in a parking lot. She was diagnosed with a right parietal subdural hematoma. She underwent an emergency craniotomy for evacuation of the hematoma. Upon placing the patient on an electrocardiograph, a ventricular paced rhythm was revealed. Pacemakers are most frequently implanted to initiate electrical activity in a heart unable to maintain its own automaticity. Patients with pacemakers may be unable to react to situations requiring increased cardiac outputs by increasing the heart rate. Depending upon the type of pacemaker present, patients may suffer from diminished cardiac output due to the loss of the "atrial kick." Pacemakers can also be affected by electromagnetic interference from devices used during surgery, particularly the electrosurgical unit. This paper discusses anesthetic management in individuals with implanted permanent pacemakers.
起搏器以及导致其植入的潜在病理生理状况给麻醉医生带来了挑战。本病例报告讨论了一名植入起搏器患者的麻醉管理。呈现了一例80岁女性患者的病例，该患者在停车场被发现无反应。她被诊断为右顶叶硬膜下血肿。她接受了紧急开颅血肿清除术。将患者置于心电图监测仪上时，显示为心室起搏心律。起搏器最常被植入以在无法维持自身自律性的心脏中引发电活动。有起搏器的患者可能无法通过增加心率来应对需要增加心输出量的情况。根据所植入起搏器的类型，患者可能会因“心房泵血”功能丧失而心输出量减少。起搏器还可能受到手术中使用的设备（尤其是电外科设备）的电磁干扰影响。本文讨论了植入永久性起搏器患者的麻醉管理。
