Nervous about surgery

Hi folks

I saw the surgoen yesterday and he wants to operate on my foot. I am really nervous about the anaesthetic with a pacemaker. I am waiting for an appt to see the anaesthetist who will assess me. I have a dual lead pacemaker which was given to me because I had sick sinus syndrom with third degree av block. Before my pm. each time I had surgery I would feel as if my whole system went down a notch and it was harder to recover due to extreme tirednes. Any comment would be a help please. Cheers

7 Comments

Surgery post-pm

by ela-girl - 2008-05-13 07:05:04

Hey, Blue.

Is this your first surgery with the pm? I was just curious because I am scheduled for a surgery in early June, and it will be my first surgery post-pm. My surgeon is making me having pre-op bloodwork and an EKG to make sure everything is in order. They were also going to check in with my EP for me to see if he clears me without having to go in and see him (I saw my EP in April). I'm not as nervous about having surgery with the pm as I am just nervous about the surgery itself. :) I hope someone will be along to put our nerves to rest!

When is your surgery? I will be praying for you and wishing you the best!

ela-girl

Why not local anesthetic?

by jeanhowser - 2008-05-13 10:05:40

Why not a local anesthetic? Have you asked? A LOT of foot surgery is done with local anesthetics . . . SOOOO much easier on the body!!!! At least ask!

Wishing you the best!

~Jean

Surgery.

by Stepford_Wife - 2008-05-13 11:05:11

Hi Billie.

I'm having surgery on my hands May 27th. I also have a dual chamber pacemaker. It will be my first surgery since the pacemaker. It will be done under local anesthesia.
All my doctor is concerned about is, if a cauterizing machine will be used. In that case, I will need to have a magnet placed over my pacemaker, and a technician overlooking the function, while the surgery is being done, to make sure everything is working OK.
Find out all the information you can regarding your surgery, so you don't have any surprises or problems afterwards.
I'm including some information regarding pacemakers and electrocautery.
Good luck,

~ Dominique ~

Magnets can be used to protect the pacemaker-dependent patient during diathermy, electrocautery or other sources of pulsed EMI ( Electro Magnetic Interference ) and can be applied over the pacemaker to avoid inhibition by such pulsed interference. However, not all pacemakers will switch to a continuous asynchronous mode when a magnet is applied. Depending on the manufacturer and model, possible magnet responses include: no apparent change in rate or rhythm; brief asynchronous pacing (10–64 beats); continuous or transient loss of pacing; asynchronous pacing without rate response. It is always advisable to confirm magnet behaviour before magnet use. For any device, the manufacturer is the most reliable source of determining magnet behaviour. This information may be sought from the manufacturer directly or via the pacing clinic where the patient attends follow-up.

Electrocautery can evoke several responses from the pacemaker. Radio frequency signals may be interpreted as cardiac impulses, leading to inappropriate inhibition. Prolonged application of cautery can repeatedly trigger the NSP, ( Noise Sampling Period ) resulting in asynchronous pacing, with function returning to normal when electrocautery is stopped. If electrocautery interference results in mode resetting, for example from DDD to VVI or VOO, AV synchrony will be lost and may result in hemodynamic embarrassment. ( Hemodynamics is an important part of cardiovascular physiology dealing with the forces the pump (the heart) has to develop to circulate blood through the cardiovascular system. Adequate blood circulation (blood flow) is a necessary condition for adequate supply of oxygen to all tissues, which, in return, is synonymous with cardiovascular health, survival of surgical patients, longevity and quality of life. To an outside observer (a physician or a nurse) these hemodynamic forces demonstrate themselves as blood pressure and blood flow paired values at different nodes of the cardiovascular system. )
Such resetting will persist even after electrocautery is stopped. In addition, implanted defibrillators may interpret electrocautery interference as ventricular fibrillation, resulting in an inappropriate shock.

My experience

by janetinak - 2008-05-14 02:05:10

I have a single lead PM but am totally dependent on PM. I had two total knee replacements (@ different times ) under general anesthesia & all went well.

I had a release from my cardio (works with EP) & my GP before 1st surgery. These two surgeries were 6 wks apart. Hope yours goes as well as mine did.

Good luck, janet

Hi, Blue,

by Gellia2 - 2008-05-14 08:05:19

I also have a dual chamber pacer. Anesthesia shouldn't be that much of a problem. I had abdominal surgery years ago and the anesthesiologist wanted to give me an epidural. I told him no. I wanted to be asleep (AWAKE!! For abdominal surgery?? I don't think so!!). He told me it was "safer for me". I told him..."No, it's just easier for YOU!!" There are precautions they can take and that's their job. He then just laughed and said "OK - You're right. No problem". And, there were no problems. I woke feeling fine (in pain but, well, surgery can hurt) and had an uneventful recovery. If they can do it with me, unless you have other medical problems, there's no reason not to have a general anesthetic if you feel more comfortable asleep. YOUR comfort should be foremost in everything they do. You can decide how you want things done. They should be smart enough to do it or you should have someone that is.
Best of luck to you and remember that the doctors are there to take care of ALL your needs. They are well paid for this by you.
Gellia

my experience

by roy haycock - 2008-05-14 12:05:38

I too have a dual chamber PM and last year had a total hip replacement and 3 months later a protatectomy, both under full anaesthetic with absoluely no post op' problems. So please be reassured. Best Wishes.

2 surgeries

by auntiesamm - 2008-05-17 03:05:16

I have had 2 surgeries since getting my dual-chamber PM implanted exactly 2 years ago. June 2007 had total knee replacement with spinal anesthesia. Also had mild sedative so I was not awake! Last month I had foot surgery with a mild sedative from which I awakened quickly and with no side effects. Was d/c'd almost immediately from outpatient surgery and came home. I think you will be fine but be sure to discuss with your anesthesiologist ALL options. Much depends on the length of surgery. For instance, my foot surgery was about a 30 min. quickie so general anesthesia would have been ridiculous. Ask lots of questions. Let us know how you are doing as you prepare. What is wrong with your toe that it must be rebuilt? Take care and God bless.
Sharon

You know you're wired when...

You have a new body part.

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