PACEMAKERS AND ELECTROSURGERY --------------------------------------------------------- Recently had a patient who required electrosurgery and had a defibrillator implanted in his chest to deal with life-threatening arrythmias. Had my nurse call the manufacturer to get their advice on the electrosurgery. Was advised to use bipolar current in the procedure. I wasn't satisfied with this and had her consult someone else at the company. They advised placing a strong magnet over the defib. to "deactivate it." I finally treated the patient without using electrosurgery. I wonder what the more surgically inclined listmembers do in this situation. Thanks in advance for any help. Harold Rehbein -------------- I use a battery operated hot tip cautery for patients with pacemakers and AICDs. There's no RF current so no need to worry---i think. Jay Barnett ----------- Your final option probably was the best one. However, if it was very important to use electrical devices in treating this patient, the option suggested by the company, that of turning off the defibrillator, makes sense. I would add to this the additional advice to do the procedure with continuous ECG monitoring - by someone capable of interpreting and treating abnormal rhythms. This might require a well staffed out-patient surgery suite or a hospital, and certainly with an external defibrillator handy. The likelihood of the patient experiencing a spontaneous episode of fibrillation might be small, but you would be in the best position to detect and treat it. Discussion with the patient and his cardiologist prior to the procedure would be advisable. Jerry Eisner ------------ The magnet approach is great if the patient is on a monitor, but I would not want to do it blindly. Also, its not just any magnet but a donut shaped one that creates the correct field. Bipolar cautery forceps, with the current between the tips and not running through is safe according to my cardiology buddies and I have used a valley lab electrosurgical device in this fashion with no problems. Most important, do your anesthesia (1% lidocaine, buffered, with Epi 1:100000); if a big area, use tumescent anesthesia (Dan's Quick and diry Formula: same stuff as above 1cc to 10cc saline) and wait 20-30 minutes. You will have a dry field, where you only have to worry about small arterioles and venules greater than about a millimeter. Others include: 1. Pencil cauteries, which have two AA batteries inside and are disposable, though Bernsco sells (or used to) a reusable one. No current and safe, but must be applied directly to the bleeder. 2. Infrared coagulator - works well, no current through the patient. Also works in wet fields. 3. CO2 laser - defocused, also works as a cautery. 4. Ligatures and overties, to tamponade any bleeders. Not as neat as you would otherwise like. 5. Hemostatics, applied under pressure; calcium alginate (Sorbsan) is my current favorite and I keep postage stamp sized pieces available for this. Far better than Gelfoam. Daniel Mark Siegel MD ---------------------- My one experience with this problem led me to call the patients cardiologist who put me in contact with the local rep. The co rep met the patient at my office and had an instrument with which he turned off the defibrillator remotely, I did the elctrosurgery and he turned the instrument back on. I certainly felt much more comfortable with this approach. L.J. Gregg,MD, -------------