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Cardiac pacemakers as an anaesthetic problem

The use of internal cardiac pacemakers has considerably extended the life of many patients suffering from complete heart block. This has created diverse anaesthetic problems which can be grouped under three headings : (1) Anaesthesia for the insertion and replacement of indwelling pacemakers. (2) Anaesthesia in paced patients who require further surgery, often for an unrelated non-cardiac condition. (3) The temporary pacing of selected individuals to cover surgery and the post-operative period. The anaesthetic problems involved in pacemaker implantation have already been covered in the literature in Englishl, German2, French3 and Italian 4. The purpose of this article is to discuss the problems arising in connection with anaesthesia for surgery in the latter two groups of patients.