The Cardiothoracic Anaesthetic Society of South Africa practice advisory for the perioperative management of pacemakers and implantable cardioverter defibrillators in South Africa

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dc.contributor.author Keene, A.R.
dc.contributor.author Motshabi, P.
dc.contributor.author Mdadla, N.
dc.contributor.author Swanevelder, J.
dc.contributor.author Turton, E.
dc.contributor.author Maakamedi, Hendrick
dc.contributor.author Murfin, D.
dc.contributor.author Vorster, A.
dc.contributor.author Drummond, L.A.
dc.date.accessioned 2022-10-13T05:05:25Z
dc.date.available 2022-10-13T05:05:25Z
dc.date.issued 2021
dc.description.abstract Pacemakers (PM) and implantable cardioverter defibrillators (ICDs) are likely to be encountered by anaesthetists in South Africa in everyday practice because of increasing rates of implantation of these cardiac implantable electronic devices (CIEDs) for an expanding group of conditions that qualify for their use. These devices are becoming increasingly sophisticated and anaesthetic perioperative management is changing with these developments. Traditionally, PM functions have been changed preoperatively to asynchronous modes because of the fear that electromagnetic interference (EMI) from the electrosurgical unit (ESU or diathermy) may cause oversensing and loss of pacing in patients who are PM-dependent. ICDs have had their anti-tachyarrythmia modes deactivated preoperatively to prevent inadvertent shocks delivered as a result of the misinterpretation of EMI as ventricular tachycardia (v-tach) or ventricular fibrillation (v-fib). Programming these devices in this manner may result in patient harm due to R-on-T phenomenon in PM set in asynchronous mode and in ICDs, undiagnosed v-tach and v-fib going untreated in patients who have anti-tachyarrythmia therapies switched off. Depending on the site of surgery, PM-on and ICD-on strategies may be acceptable. Magnet use intraoperatively can be used safely to change PM and ICD settings with the advantage that reversal to normal settings can be achieved by removal of the magnet once EMI is no longer in use. Intraoperative magnet use mandates that the device is interrogated preoperatively and that the results of magnet application are known to the anaesthetist in advance. Where management protocols stated may be controversial, the American Society of Anesthesiologists (ASA) survey of an expert consultant panel as well as member anaesthetists is published, as well as the Cardiothoracic Anaesthetic Society of South Africa (CASSA) committee responses to these controversies. en_US
dc.description.department Anaesthesiology en_US
dc.description.uri http://www.sajaa.co.za/index.php/sajaa en_US
dc.identifier.citation Keene, A.R., Motshabi, P., Mdadla, N. et al. 2021, 'The Cardiothoracic Anaesthetic Society of South Africa practice advisory for the perioperative management of pacemakers and implantable cardioverter defibrillators in South Africa', Southern African Journal of Anaesthesia and Analgesia, vol. 27, pp. 57-63, doi: 10.36303/SAJAA.2021.27.6.S1.2710. en_US
dc.identifier.issn 2220-1181 (online)
dc.identifier.issn 2220-1173 (online)
dc.identifier.other 10.36303/SAJAA.2021.27.6.S1.2710
dc.identifier.uri https://repository.up.ac.za/handle/2263/87663
dc.language.iso en en_US
dc.publisher Medpharm Publications en_US
dc.rights © 2021 The Author(s). Open Access article distributed under the terms of the Creative Commons License [CC BY-NC 3.0]. en_US
dc.subject Anaesthesia management en_US
dc.subject Pacemaker en_US
dc.subject Defibrillator en_US
dc.subject Implantable cardioverter defibrillator (ICD) en_US
dc.subject Cardiac implantable electronic device (CIED) en_US
dc.subject Electromagnetic interference (EMI) en_US
dc.subject Ventricular fibrillation (v-fib) en_US
dc.subject Ventricular tachycardia (v-tach) en_US
dc.subject Cardiothoracic Anaesthetic Society of South Africa (CASSA) en_US
dc.subject.other Health sciences article SDG-03
dc.subject.other SDG-03: Good health and well-being
dc.subject.other Health sciences article SDG-09
dc.subject.other SDG-09: Industry, innovation and infrastructure
dc.subject.other Health sciences article SDG-17
dc.subject.other SDG-17: Partnerships for the goals
dc.title The Cardiothoracic Anaesthetic Society of South Africa practice advisory for the perioperative management of pacemakers and implantable cardioverter defibrillators in South Africa en_US
dc.type Article en_US


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