Anesthesia for generator change

What kind of anesthesia have you had for a generator change? I was told I would just get local anesthesia around the pacemaker site. I am a very nervous person and I don't think I can do it that way. I think I will need some IV sedation, just to make me not so aware. I don't want to be "knocked out" but I don't want to be fully awake either. I have a choice of two doctors, one who only uses local and one who gives IV sedation.


9 Comments

sedation

by Tracey_E - 2008-10-17 01:10:58

I've always been offered a sedative in preop. I say no thanks, but they always offer it. You usually meet with the anesthesiologist as part of the preop testing, just tell them you get nervous and you don't want to remember, they will take care of you!

My replacements have been done under general rather than local because my pm is buried very deep. I am the exception, not the rule!

Hi,

by Gellia2 - 2008-10-17 02:10:37

I've had seven battery changes now. In the beginning I had only a local. That got to be "old hat" and I was no longer THAT curious. Now they use a drug called Propofol. I don't remember a thing and yet I can still do what they need to have me do. It allowed me to fully wake up with no "hangover" feeling and no nausea at all. For me, this last change has been the easiest yet. I went in and was finished and on my way home within five hours feeling great.
Propofol must be administered by a licensed anesthesiologist.
Hope this helps!
Best to you,
Gellia

Out cold...

by turboz24 - 2008-10-17 03:10:41

I have been under general for all my ICD procedures and plan to be under general for all of them. I was out cold for the EP study and implantation, and was out cold for my ablation as well. My ICD implant is just under the skin of my left chest, so it's not deep, but when it's replaced, it will be moved to sub-pectoral, so I will be out cold for that as well.

I personally don't want to experience and of the pushing, cutting, etc that occurs during those procedures, so I demand general.

Hi,

by Gellia2 - 2008-10-17 04:10:56

Having an IV anesthetic would make you "think" you are out cold. General anesthetic takes over your airway and your breathing. A tube is placed down your throat and the breathing is done for you. Pacemaker implantation would normally not use a general anesthetic.
Under normal circumstances, an IV line is started and you are given an anesthetic through it. It places you into a "twilight sleep". You are given a local anesthetic to the implantation site and you feel nothing cause you think you are asleep. You feel nothing at all and know nothing that goes on.
Propofol is IV and you wake up feeling like it was five minutes, you knew nothing and your incision doesn't hurt because you still have the after effects of the local.
It's a breeze that way. If you want to know nothing, get IV anesthesia. There are many different types. Ask your doctor.
Best to you,
Gellia

Does...

by turboz24 - 2008-10-17 05:10:17

Does the IV sedation include a paralitic to prevent you from moving also?

Had a breathing tube...

by turboz24 - 2008-10-17 05:10:49

I ended up with the whole thing, breathing tube and all. I had to sit in the recovery room after the procedures, so I'm pretty sure I was under general.

Paralytic Agents

by maryanne - 2008-10-17 06:10:50

Turbo...and implant of an ICD is a bit different than a PM implant as I am sure you are aware.

When someone goes under a general anesthetic it is the anesthesiologist who decides the drugs that are going to be used. In Canada I have not heard of them using propofol for PM implants but I guess there is no reason why they couldn't. We usually use propofol for cardioversions...reason for that is it has a quick onset and quick recovery as others have said, there is very little effect from feeling like you were druged. It is a great drug...but as I say I am not aware of it being used for PM implants.

Paralytic agents are generally reserved for when they want the patient completely anesthesitized and let the ventilator breath for you. That generally is the case for open heart, or lung or for long surgeries... In an ICU setting we have used paralytic agents to help a patient who has gone into ARDS, the lungs need to rest and recover..the body wants to fight putting extra stress on the lungs...making them work harder...so they chose to paralyse the patient making them totally ventilator dependent and hence resenting the lung....So Turbo to answer your question yes Paralytic drugs prevent you from moving. And if these drugs are used they are used for as short a time period as possible.

There are many drugs anesthesiologist use and they use them for a variety of reasons. They have to look at how drugs are metabolized...how are they excreted....does the patient have renal insufficiency and if so then they will cautiously use drugs that are excreted by the kidneys are maybe not use them at all....what is the patients past experience with sedation.....maliganant hypothermia is another question anesthesologist ask of patients whether the patient or anyone in their family has ever had problems with anesthestic and what was it?

So in a nut shell....althought there are common grounds for many drugs...it's very individual...what works for one may not work for another...

So before every surgery an anesthesiologist will ask you questions about past surgeries if you had any complications...tell them how you are feeling and ask if you can have something....they generally are very accomodating.

Cheers, Mary Anne

Sedation

by maryanne - 2008-10-17 12:10:50

I am not aware of people being put under a general anesthestic for a generator implant or change...there might be people out there but I haven't heard of any They do give you IV sedation if you request. You would be correct in that they only give you local freezing at the insertion site, similar to what you get at the dentist.

There are two things you can do...you can ask to have little tablet called Ativan/Lorazepam prior to your procedure, and then ask for something intra-op. I am sure the doctor would be more than willing to accomadate this request.

You can also do meditation if you are so inclined or I have even ask the doctor if they had some music I could listen to...often they do.
Best of luck to you

Propofol

by melland - 2008-12-03 08:12:39

I had my ICD implanted at the end of October. Had the propofol IV and a local at the implant site. It was a breeze. I could feel a little pushing and pulling pressure when the ICD was delivered to the pocket, but that was it. Was up and out of bed within 4 hours of the surgery.

I'll take this method over going all the way under anytime.

Tim

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