Local anesthetic for replacement

Is it necessary to be "put under" for a pacemaker replacement?  Will a local anesthesia be sufficient  Due to unusual circumstances I will not have anyone available to pick me up. I'm hoping to drive myself home. This will be my third pacemaker 



They would much prefer to use local only

by crustyg - 2020-12-06 16:12:56

Have a search for recent posts on this topic.  Your EP doc would much prefer to use local, although *some* like to provide some additional sedation (this latter *would* prevent you from driving for the rest of the day).

So local *only* is perfectly reasonable and typical and you will be able to drive there and home later in the day.

Best wishes.

Local Yes, Driving Home Probably Not

by Swangirl - 2020-12-06 16:14:09

I just had a local for my pacemaker implant in 2018 but I also was given an IV cocktail of fentanyl and other drugs that would have made it unsafe for me to drive.  If it's a replacement and you just have a local it might be different for you.  

Driving home after replacement

by Persephone - 2020-12-06 16:57:02

Hi Rodger, I'm not sure if current conditions are offering any options, but in my experience, outpatient surgical facilities require identification of who's going to drive you home following a procedure, including that person presenting themselves and perhaps signing an authorization form.  So you'll want to check with the facility to ensure you wouldn't run into a roadblock if you show up unaccompanied.

Swangirl makes a good point

by crustyg - 2020-12-07 13:27:37

The 'cocktail' of fentanyl+ is the 'additional sedation' that some EP-docs doing the replacement might generally prefer to administer - but only *IF* you consent to them. Decline these and you can drive yourself home.

My EP-doc prefers to use local + sedation for PM and lead placement.  But I had the whole thing done under local.  When I said (not knowing precisely where we were in the procedure) 'May I ask a question' the curt answer was 'No.'  So I kept quiet.

It's a *lot* more stressful for the EP-doc doing the first PM (pocket creation, sheath into subclavian vein, lead placements and anchoring) to have a fully awake patient - and even more so if the veins aren't easy to cannulate - I was dehydrated so my veins were small.

BUT PM replacement is *much* easier and a good EP-doc shouldn't have any problems doing it all under local.  There *can* be some tough scar tissue around the PM, which takes some digging out, but that's not the routine.

It really is *your* choice.

Read the Fine Print

by Swangirl - 2020-12-07 16:00:11

crustyg makes a good point to know what you are being given.  I just signed the forms that were presented without realizing I had choices or could opt out of some of the drugs.  Because I got two new leads and a new pacemaker it took probably 90 minutes and while I was semi-conscious I was quite relaxed.  I did tell the anesthesia person that "a little goes a long way" and he started off with just half of what he was prepared to give and that was plenty.  


by AgentX86 - 2020-12-07 20:16:38

There is no reason a local can't be used for a replacement. I had locals for both (same time) my implant and catheterization for my AV ablation.  My doctors don't like to use any more sedation than required for the procedure.  The only pain was when they made the pocket itself so for a generator replacement a local should be able to handle it easily.

As far as driving yourself home, I can't imagine a reason that it would be impossible.  You may have some pain driving but you'll be clear mentally.  Since it's just a generator change, there is no risk of a lead pulling loose and the chance of a catastrophic generator fault is zero.

I don't know what their formal position would be (probably covering ass) or local legal restrictions but there is no reason you couldn't.  Shouldn't?

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