Electrosurgery

I'm scheduled for a LEEP procedure in January - a GYN cervical surgery. They will use electrocautery. They've scheduled me for a pre-op appointment and an Anesthesia appointment (even though this should be local anesthetic only).
Has any other woman had a LEEP while having a pacemaker? The scheduler today said my surgeon has been communicating back and forth with my EP Cardio, and it sounds like either he also will have to be there during the surgery or a rep from Medtronic. They had said that Anesthesia is trained to work on the pacemaker during this procedure so I'm guessing that's why they will be there...but why also Cardio or a rep? Does it take two people to manage the pacemaker, and what will I be feeling from it during all this, will I pass out? I'm 100% dependant on the pacer.
This has me quite worried - not only about the procedure itself for precancerous cells, but also because I don't know what to expect from my pacemaker. Is there much danger?
This is normally an office procedure, but of course mine has to be done in the hospital.
Thanks for any help!

10 Comments

I never thought

by denho - 2013-11-07 02:11:25

about my settings maybe having to be reset! They've called me in a few times after my original insertion (in 2010) becuase the pacer wasn't working right with my heart. My last reset was only two weeks ago - one of my leads wasn't working right at all, they caught it during my remote interrogation.

My EP is in the same practice (UWMC) as my GYN and in the same hospital as where my surgery will be, so he will have my current settings.

I of course hate the feelings you get when they just check out the pacer (fast, skipping, slow, etc) but shudder to think of what might happen during this procedure.

Thanks for the help
Denise

Been there

by cohara - 2013-11-07 06:11:42

I am one of the people who took my pm settings into surgery. The nurses even put them in a plastic sleeve to keep them safe. I had my ovaries removed with electrocautery with no issues. If the site is below the waist and they place the ground plate on your thigh, you should be fine. I also had surgery on my thyroid, six inches away from my pm, without any issues. However, I had good, down to earth discussions with both surgeons and both anesthesiologists.

Most hospitals require that a pm be interrogated after electrocautery. It is a safety precaution and makes sense. My pm's settings didn't change, but it is best to be safe. I am pacemaker dependent, so I leave nothing to chance.

Be proactive and ask questions. The best person to look after your body is you.

Good luck,
Carol

Anesthesia Article

by lbdina - 2013-11-07 08:11:31

denho,

I can't comment on LEEP, however I stumbled upon a very interesting and well written article written by a doctor to anesthesiologists about pacemakers, electrocautery, etc. The purpose of the article was to educate anesthesiologists on how to safely deal with pacemakers. It's worth a read, and is actually fairly humorous in a few parts.

Lou

http://www.cardiacengineering.com/pacemakers-wallace.pdf

Thanks, Carol!!!!!

by donr - 2013-11-07 09:11:45

Haven't seen you around lately, so did not know if you would show up & catch this one.

I was the second one to carry their settings into the OR. They looked at me like I had lobsters crawling out of my ears!

Can you remember who was third?

All we need is for denho to carry hers in w/ her & we can form a choir.

Don

That would be me

by Grateful Heart - 2013-11-07 09:11:52

I'm #3...... I took my settings to my surgery too. I had a total hip replacement 7 months ago. I have an ICD so they had to turn off the defibrillator and put defib pads on me just in case, which I understood. I am also paced 100%.

The Nurse took copy of my settings it and then the rep said he didn't need it because he would see the settings with the programming. The problem was, he was going to use a magnet instead. He showed up and did not want to do his job. The hospital can just use a magnet....they didn't need him for a magnet. The Anesthesiologist finally told him to use the programming. It was all pretty upsetting right before surgery. The Doctors were not happy with him (the rep) either, they had to call him numerous times to return after the surgery to reset the settings.

You probably won't encounter that. If your EP wants to be there...that is great, I wish mine was there.

Grateful Heart

Sounds like you...

by donr - 2013-11-07 09:11:54

...have a pretty decent handle on things already.

READ Lou's web site link. It really is the essence of what you need to know.

Here's the MOST IMPORTANT part of it for you: Get a copy of your settings printed out. Take it with you to the OR prep area. Insist that they have a Mfgr's Rep come to check your PM AFTER the procedure to verify that your PM has the correct settings on it.

You need to buttonhole the anesthesiologist during the pre-op few minutes when they talk to you. The essence of the conversation is that you have a PM. Ask them how much experience they have had w/ PM's. Don't let them walk away w/o getting a decent discussion of what they know & how they plan to handle electrocautery.

Wallace's article explains it all. Electrocautery - if it is needed - requires a "Ground Plane," a patch they stick on your body to act as a return for the electric current used by the Electrocautery device. Ask them to put it on one of your legs, NOT your body's trunk. That helps by keeping any stray current away from the PM/heart area.

Remember - if you are zonked out by the anesthesiologist - you lose all influence over what happens to you.

IIRC, there are three of us who went into surgery waving a copy of our settings. Any good anesthesiologist just might have to disable your PM if things go sour for them during the procedure. Be prepared - that's NOT just for Boy Scouts!

BTW: It does NOT require two people to manage a PM, but it sure is nice to have the person there who eats, breathes & lives PM's - and also has the computer to check it, & reset it.

Don

I would love

by denho - 2013-11-07 10:11:02

to be part of the choir except I don't have my settings and they're in the computer there anyway at UWMC which is where all my doctors are and where the surgery will be. I hope my regular device nurse or the rep will be there, this rep is really good and I've had him adjust my pacer more than once (my heart keeps changing what if anything it wants to do on its own).
I'm going to be sure to ask about them checking the settings after the procedure.
I feel a lot better hearing from others who have gone through surgeries requiring pacer intervention...and especially Carol who has gone through a really similar surgery. Thanks to all of you for your support and advice, it really helps.

Even after three years, I still am not really comfortable with having a pacemaker...though it's much better than when my heart used to stop or just go crazy.

Denise

No apolgy needed

by Grateful Heart - 2013-11-07 11:11:41

That's what happens when you're #3. lol

Grateful Heart

Who is captain ...

by donr - 2013-11-07 11:11:49

... of your ship; who is master of your soul?

I don't care if your settings are in their computer, you should have a copy of them. (A spear in a neighbor's hut does not help when the lion is in yours!) Get at least ONE copy of a download to have & to hold so you have access to them. This is critical. You should not go into an OR "Hoping" that a certain person will be there. Anesthesiologists are notorious for not showing up at the last minute - Called "Bait & switch." I've had that done to me TWICE now, & was saved by knowing what my settings were.

I had a pre-op anesthesiologist once sit down w/ me the night before & we talked all about this - he promised me faithfully that he would be there the next AM. He had done me for a Colonoscopy a few yrs before & remembered me (Probably because I was a royal PITA about the PM). Next AM guess who shows up - NOT him. So we went through the whole drill again. Fortunately he knew all about PM's & passed his oral exam quite handily. I based my questioning on the ref that Lou gave you.

Don

Apology

by donr - 2013-11-07 11:11:53

To Grateful Heart for forgetting that she was #3 that I knew who took her settings in with her.

I remember it all now. \

Can I plead old age?

Don

You know you're wired when...

Microwave ovens make you spark.

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