PREOPERATIVE
DIAGNOSIS:
1.
End-of-service with pacemaker generator.
2.
Pacemaker dependent.
POSTOPERATIVE
DIAGNOSIS:
1.
End-of-service with pacemaker generator.
2.
Pacemaker dependent.
PROCEDURE:
Pacemaker
generator replacement.
ANESTHESIA:
Monitored anesthesia care plus local.
ESTIMATED BLOOD LOSS: None.
INDICATIONS: The
patient is a very pleasant 88-year-old gentleman status post initial
single-chamber ventricular pacemaker insertion 01/10/96, and status post pacemaker
generator replacement 02/12/02, where recent testing found that the pacemaker
was at elective replacement interval. He
is pacemaker dependent. He was referred
for pacemaker generator replacement. The indications, risks, benefits of
procedure were explained to the patient as well as to his wife and neice. He understood and consented for the
operation.
FINDINGS: The
explanted pacemaker is a St.
Jude Medical model #5136, serial #605300.
The chronic right ventricular lead is a St. Jude Medical model # 1246,
T/58, serial #CB18308. The implanted
pacemaker is a St. Jude Medical Zephyr XL SR, single chamber rate responsive
pacemaker, model #5626, serial #1984162.
Pacing parameters for the right ventricular lead, R-waves were not
measured as he is pacemaker dependent, impedance 648 ohms, and pacing threshold
0.4 volts.
PROCEDURE IN DETAIL: A
time-out was performed prior to start of the operation. The patient was correctly identified as well
as the procedure. With the patient under
monitored anesthesia care, the patient's left upper chest and neck were prepped
with DuraPrep and draped sterilely. A 1%
Xylocaine was infiltrated locally over the more superior of the two pacemaker
scars. The pacemaker scar was
incised. The subcutaneous tissues were
divided with electrocautery. The fibrous
capsule surrounding the pacemaker generator was opened and the pacemaker
explanted. The lead was loosened and
removed from the pacemaker generator and quickly attached to the pacemaker
cable for pacing and testing, as the patient is pacemaker dependent. Pacing parameters were excellent. The lead was then inserted into the
receptacle of the pacemaker generator and tightened down.
The pocket was irrigated with antibiotic
solution. Hemostasis was fine. The generator was inserted into the
pocket. The incision was closed in
layers with continuous Vicryl sutures including the subcuticular layer. Dermabond and a Coverlet were applied.
The patient
tolerated the procedure well and there were no complications. Sponge, instruments, and needle counts were
correct. The patient was transported to
the post anesthesia care unit in stable condition
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