Cardiac Patients for Non-Cardiac Surgery: Anesthetic Management in Patients with Permanent Pacemaker

  • Eva Oktavia Ukrida
  • Eva Oktavia Anesthesiology Department, Medical Faculty of Ukrida, Jakarta, Indonesia
Keywords: anesthesia; arrhythmias; electrophysiology; dysrhythmias; pacemaker


Permanent pacemaker (PPM) are being used in greater frequency in managing patients with electrophysiology disorders. These patients can be presented for either cardiac or non-cardiac surgery after their device implantation. They also will undergo either general or regional anesthesia to facilitate the surgical procedure. As an anesthesiologist, understanding patients’ condition, pacemaker care and safe anesthetic technique of choice are very important to provide safe patient management.  Therefore, this literature reviewed and summarized a systematic approach which can be followed in managing these patients.

Various approach and guidelines have been discussed in the literature on how to manage patients with PPM who will undergo anesthesia. In this literature, the American Society of Anesthesiology (ASA) standard was used as a framework for managing patients with PPM. Meanwhile, the decision of anesthesia technique that being chosen should be based on patients’ clinical condition, the surgical procedure itself, the duration of surgery, and the convenience of the surgeon.

Overall, patients with PPM require special attention in perioperative management. Both anticipations of the patient’s condition and the performance of PPM must always be considered to provide safe anesthesia practice.


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1. Morgan G, Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail's Clinical Anesthesiology Cases. 5th ed. McGraw-Hill Education; 2013.
2. Chakravarthy M, Prabhakumar D, George A. Anaesthetic consideration in patients with cardiac implantable electronic devices scheduled for surgery. Indian J Anaesth. 2017; 61(9):736. doi:10.4103/ija.ija_346_17.
3. Govindswamy S, Geetha S. Anesthesia management of an elderly patient having permanent pacemaker for total hip replacement. Karnataka Anaesthesia Journal. 2015; 1(4):194. doi:10.4103/2394-6954.180655.
4. Rastogi S, Goel S, Tempe D, Virmani S. Anaesthetic Management of Patients with Cardiac Pacemakers and Defibrillators for Non-cardiac Surgery. Annals of Cardiac Anaesthesia. 2005; 8:21-32.
5. Sameera V, Pandia M, Bindu B, Goyal K. Anesthetic considerations and successful management of a patient with permanent pacemaker for cervical spine instrumentation. Saudi J Anaesth. 2018; 12(4):634-6. doi:10.4103/sja.SJA_125_18.
6. Bryant HC, Roberts PR, Diprose P. Perioperative management of patients with cardiac implantable electronic devices. BJA Education. 2016; 16(11):388-396. doi:10.1093/bjaed/mkw020.
7. Hanafy D, Yuniadi Y, Raharjo S et al. Pedoman Terapi Memakai Alat Elektronik Kardiovaskular Implan (Aleka) Perhimpunan Dokter Spesialis Kardiovaskular Indonesia 2014. Indonesian Journal of Cardiology. 2015:171-245. doi:10.30701/ijc.v35i3.431.
8. Hariharan U, Sonowal S, Kaur M. Pacemaker and Geriatric Anaesthesia: A special report. International Journal of Medical Reviews and Case Reports. 2018;2(Reports in Surgery and Dermatolo):1. doi:10.5455/ijmrcr.pacemaker-geriatric-anaesthesia.
9. Diprose P, Pierce J. Anaesthesia for patients with pacemakers and similar devices. BJA CEPD Reviews. 2001;1(6):166-170. doi:10.1093/bjacepd/1.6.166.
10. Elsik M, Fynn SP. Permanent pacemakers and implantable defibrillators. In: Mackay JH, Arrowsmith JE, eds. Core Topics in Cardiac Anesthesia. 2nd ed. Cambridge: Cambridge University Press; 2012:241-248. doi:10.1017/CBO9780511979095.044.
11. Miller R, Cohen N. Miller's Anesthesia. Philadelphia, Pa: Elsevier, Saunders; 2015.
12. Sanghavi P, Shah K, Patel N, Sharma G, Goyal S, Patel B. Perioperative anaesthetic management of patients with cardiac pacemakers in non-cardiac surgery- A Case Report. Gujarat Medical Journal. 2014;69(1):96-97.
13. Stone M, Salter B, Fischer A. Perioperative management of patients with cardiac implantable electronic devices. Br J Anaesth. 2011;107:i16-i26. doi:10.1093/bja/aer354.
14. Rapsang A, Bhattacharyya P. Pacemakers and implantable cardioverter defibrillators – general and anesthetic considerations. Brazilian Journal of Anesthesiology (English Edition). 2014;64(3):205-214. doi:10.1016/j.bjane.2013.02.005.
15. Stoelting R, Hines R, Marschall K. Handbook For Stoelting's Anesthesia And Co-Existing Disease. Philadelphia, PA: Elsevier/Saunders; 2013.
16. Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter-Defibrillators. Anesthesiology. 2011;114(2):247-261. doi:10.1097/aln.0b013e3181fbe7f6.
17. Cho C, Yu J, Sung L, Chung J, Noh C. Comparison of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy (Lithoclast®) Alone or in Combination with Ultrasonic Lithotripsy. Korean J Urol. 2010;51(11):783. doi:10.4111/kju.2010.51.11.783.
18. Smith A. Smith's Textbook Of Endourology. Chichester, West Sussex: Wiley-Blackwell; 2012.
19. Mehrabi S, Zadeh A, Toori M, Mehrabi F. General Versus Spinal Anesthesia in Percutaneous Nephrolithotomy. Urol J. 2013;10(1):756-761.
20. Movasseghi G, Hassani V, Mohaghegh M et al. Comparison Between Spinal and General Anesthesia in Percutaneous Nephrolithotomy. Anesth Pain Med. 2013;3(3). doi:10.5812/aapm.13871.
21. Canales B, Pugh J. New instrumentation in percutaneous nephrolithotomy. Indian Journal of Urology. 2010;26(3):389. doi:10.4103/0970-1591.70579.
22. Alex S, Saneesh J, Rao R, Upadya M. Anaesthetic management of a patient with sick sinus syndrome for exploratory laparotomy. Southern African Journal of Anaesthesia and Analgesia. 2010;16(6):24-26. doi:10.1080/22201173.2010.10872713.
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How to Cite
Oktavia, E., & Oktavia, E. (2020). Cardiac Patients for Non-Cardiac Surgery: Anesthetic Management in Patients with Permanent Pacemaker. Indonesian Journal of Cardiology, 41(1), 32-9.