What sedation is used for pacemaker insertion

Conscious sedation and implantable devices

There is a paucity of research on the use of CS during ICD or pacemaker implantation. Pacemaker patients generally require small amounts of i.v. sedation, in conjunction with local anesthetic agents, to relieve incisional discomfort. Because of innovations in ICD technology, little difference now exists between ICD and pacemaker placement The pacemaker insertion site will be cleansed with antiseptic soap. Sterile towels and a sheet will be placed around this area. A local anesthetic will be injected into the skin at the insertion site. Once the anesthetic has taken effect, the physician will make a small incision at the insertion site.. Pacemaker Insertion. The Pacemaker Implant Procedure. Definition. This is a procedure to insert an artificial pacemaker. A pacemaker is a small, battery-operated device. It helps maintain a normal heartbeat by sending electrical impulses to the heart. Anesthesia. Local anesthesia is used to numb the area. Description of the Procedure. You. Local anesthesia is sufficient and, therefore, limits the need for anesthesiologists during pacemaker insertion. However, complicated, high-risk patients are now presented for pacemaker insertion Implantation of pacemaker usually involves a combination of local anesthesia and conscious sedation. Infiltration of skin and subcutaneous tissue at the implant site with 1-2% lidocaine provides sufficient local anesthesia for the majority of implant procedures. However, to obtain optimal anesthesia, conscious sedation in the form of carefully titrated IV midazolam and fentanyl is recommended. On rare occasions, general anesthesia may be required in an extremely uncooperative patient

Ahms 160 ch

Implantation procedures are generally performed under moderate sedation, but on occasion there may be a need for the sup­port of an anesthesiologist Introduction. Approaches to sedation in the electrophysiology (EP) laboratory range from intravenous sedation techniques to general anesthesia (GA) (Table 1, 1).Although the provision of GA requires a dedicated anesthesia provider, controversy exists as to whether intravenous sedation in this complex patient population can or should be undertaken by a proceduralist‐directed nurse. Epicardial implantation is often used in children and people who have heart surgery at the same time as a pacemaker implantation. It's carried out under general anaesthetic, which means you'll be asleep throughout the procedure

Also, newer pacemakers have sensors that detect body motion or breathing rate, which signal the pacemakers to increase heart rate during exercise, as needed. Two smaller, leadless pacemakers, which can be implanted directly into the heart, have been approved for use in the United States Dual-chamber pacemakers - 2 pacemaker checks in the first 6 months after insertion, then 1 every 6 months or during any pacer malfunction There is a 90-day global period for pacemaker insertion; as a rule, any pacer checks during that time are included in the global period Permanent pacemaker insertion is considered a minimally invasive procedure. Transvenous access to the heart chambers under local anesthesia is the favored technique, most commonly via the subclavian vein, the cephalic vein, or (rarely) the internal jugular vein or the femoral vein It's called conscience sedation. It will be moderate or deeper than that. If we sense that you are starting to feel pain, the will adjust the sedation. What we do is make an incision to form like a pocket, to place the pacemaker in. It will usually be on the left side of your chest. That is the traditional placement area for your pacemaker

Propofol alone appears to provide excellent sedation for the majority of patients, but for painful procedures, additional opioid may be needed Recovery of a patient after general anesthesia will be in the 4th floor PACU, while the patient who had MAC will be recovered in the EP holding room unless the anesthesia provider felt that a higher level of care (PACU or ICU) is necessary due to co-morbidities or intra-operative events, or if the length of recovery is expected to exceed the.

Pacemaker Insertion Johns Hopkins Medicin

A pacemaker can be implanted using the endocardial or epicardial approach. The endocardial (transvenous) approach is the most common method. A local anesthetic (pain-relieving medication) is given to numb the area. An incision is made in the chest where the leads and pacemaker are inserted Purpose: To present the techniques of anesthesia management used during percutaneous carotid interventions involving balloon dilation and stent deployment. Methods and results: Two access routes may be used for carotid angioplasty, and the anesthesia techniques for each are different. In the conventional common femoral artery approach, the patient is sedated, heparinized, and ventilated by. Pacemaker Insertion or Generator Change Single Chamber Pacemaker Uses one lead in the upper (1) if you had a new pacemaker implanted, do not use your arm on the same side as the device. A sling can be provided as a sedation to you once you are in the procedure room Pacemaker insertion anesthesia. Common Questions and Answers about Pacemaker insertion anesthesia. pacemaker. One of the electro-cardiologists even mentioned her frustration with the lack of ongoing studies of patients with this problem. They seem to stop shortly after the insertion of a pacemaker. Most of those people however have incidents.

an 82 yr old patient is scheduled for pacemaker insertion. what form of anesthesia is most likely planned? pulse oximetry. noninvasive method of measuring oxygen in the blood by using a device that attaches to the fingertip. Bupivacaine (Marcaine) Local anesthetic with longest duration

Pacemaker Insertion Cardiac Surgery SUNY Upstate

  1. Cardiac Implantable Electronic Device (CIED) is typically used, refers to any both Pacemakers and Implantable Cardioverter-Defibrillators (ICD). Pacemakers: Pacing can be provided in several ways, including application of external pacing pads, urgent insertion of a transvenous pacing lead via central venous access, and implantation of permanent.
  2. Although pacemaker implantation is usually performed under general anesthesia or MAC sedation, in patients with compromised cardiac function, as in our patient with concomitant SAS, there exists a risk of significant mobility and mortality. There is no consensus on which anesthetic technique is safer for non-cardiac surgery in SAS patients
  3. g are in anyone who is pacer-dependent, rate-responsiveness, certain clinical conditions (dilated cardiomyopathy, HOCM, pediatric patients), procedures in the chest/abdomen, and others (see Boxes 25-4 and 25-6) [Kaplan, JA et al. Kaplan's Cardiac Anesthesia: The Echo.
  4. Anesthesia for AICD and Pacemaker Insertion questionControl room of cath/EP lab answerfree of X-ray, personnel can monitor imaging, mapping and ablation questionLimitation of cath(PE) labs fo

What to Expect During Pacemaker & ICD Implant Procedures. This information is designed to provide you with an overview of what to expect before, during and after your device implant procedure. It should serve only as a guide, as treatment will vary for each patient. A nurse will review specific instructions with you before your procedure Generally the pacemaker is implanted in a sterile laboratory or operating room by a specialist (cardiologist, surgeon, or cardiac electrophysiologist) with experience in this procedure. Local anesthesia and often conscious sedation are used to make the procedure as pain-free as possible. General anesthesia is rarely required Local Anesthesia. Administering effective local anesthesia is a valuable skill that all pacemaker implanters should master. The aim of this article is to describe the principles of local anesthesia for pacemaker implantation in the pectoral region. Practical methods will be presented during each step in subsequent sections Pacemaker or AICD Insertion. 1. What the anesthesiologist should know before the operative procedure. Pacemakers and AICDs are implantable devices, used to deliver electrical therapy to the heart.


Anesthesia for Pacemaker Insertion - Isidra Veve, Luisa

A pacemaker is inserted by your cardiologist in either the cardiac catheterization or electrophysiology laboratory. You will receive local anesthesia to numb the incision site. Sedation medication can be given to help you relax and many patients sleep during the procedure Dual chamber pacemaker implantation. 2. Radiological supervision. 3. Subclavian venogram. ANESTHESIA: Local with conscious sedation. ANESTHESIOLOGIST: None. DESCRIPTION OF PROCEDURE: After informed consent, the patient was brought to the cardiac catheterization laboratory. Demerol 25 mg, Phenergan 12.5 mg, and Kefzol 1 gram IV were used as. Pacemakers are used to treat patients with brady-arrythmias, slow heart rhythms that may occur as a result of disease in the heart's conduction system (such as the SA node, AV node or His-Purkinje network). A leadless pacemaker is small self-contained device that is inserted in the right ventricle of the heart

Use 33212, 33213, 33221, 33230, 33231, 33240 as appropriate in addition to the thoracotomy or endoscopic Epicardial lead placement codes (33202 or 33203) to report the insertion of the generator if done by the same physician during the same session Anesthesia for permanent transvenous pacemaker insertion 00532 4 Anesthesia for access to central venous circulation 00534 7 Anesthesia for transvenous insertion or replacement of pacing cardioverter-defibrillator 00537 7 Anesthesia for cardiac electrophysiologic procedures including radiofrequency ablatio

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) pacemaker.. my first pacemaker last me for 18yrs. and just got my 2nd. pacemaker Dec.2006.. my pacemaker was implanted in my upper chest on the right side.. only thing i hate the surgery doctor told me he would use the same cut as the other pacemaker but when i woke up he cut me in another spot.. well i can say.. ask your doctor his he using. A pacemaker programmed to respond to magnet placement will usually produce asynchronous pacing beats that confirm the device is a pacemaker, allow confirmation of capture, and permit evaluation of the status of the battery (for all pacemakers, the magnet-associated pacing rate decreases as the battery becomes depleted, but the details are. The Cove Point Foundation Congenital Heart Resource Center is the world's largest resource for information on pediatric and adult congenital heart disease. Cove Point contains comprehensive information on all congenital heart defects, including Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Hypoplastic Left Heart Syndrome (HLHS), and Tetralogy of Fallot (ToF) Background. Implantable cardioverter-defibrillators with transvenous leads permit the use of simplified implantation techniques similar to those used for the insertion of permanent pacemakers. However, implantation of ICDs without general anesthesia has thus far gained limited acceptance. Methods

Pre-procedure sedation may be given before the patient is moved to the operating theatre, but if sedation is used at all, it is often simply given in the theatre itself. Most PPMs are implanted on the left side. This is because it is more natural for right handed operators and it is easier to position the leads (especially the atrial lead) Regional Anesthesia for Pacemaker Insertion RENE MARTIN, M.D.. JEAN-YVES DUPUIS, M.D.t JEAN-PIERRE TETRAULT, M.D.* From the Department of Anesthesia, University of Sherbrooke, Sherbrooke, Canada Methods Forty patients of both sexes, who came for their first cardiac pacemaker insertion, were studied prospectively A pacemaker keeps the heart beating regularly, and inserting one into the chest requires surgery. This is a relatively safe procedure. Learn more about heart pacemaker surgery here

Transvenous pacemakers are used to stabilize cardiovascular function in a patient who suffers from arrhythmia and heart failure. An electronic device is implanted in the right heart chamber by wires passing through the large vein of the neck or groin. This is connected to a pulse generator, powered by a battery to deliver impulses causing the heart to contract rhythmically Single-chamber pacemakers, the most commonly used devices, deliver electrical impulses to the right atrium (upper chamber) of the heart.(The sinus node, a cluster of cells in the right atrium, is the heart's natural pacemaker.); Dual-chamber pacemakers are used when the timing of the chamber contractions is misaligned.The device corrects this by delivering synchronized pulses to the right. • Monitoring and anesthesia technique with due considerations to patients CVS status. • Initiate invasive arterial pressure monitoring in addition to standard monitoring. • Avoid electrocautery use, If necessary consider use of bipolar or harmonic scalpel. • Be ready for alternate mode of pacemaker and defibrillator if necessity arises Anesthesia. Local anesthesia is used to numb the area. Description of the procedure. You will lie flat on a table. A small cut will be made beneath the collarbone. The pacemaker is placed through the cut. The wires (called leads) will be threaded through a vein from the collarbone to the heart. Pacemaker insertion. Johns Hopkins Medicine.

5: Techniques of Pacemaker Implantation and Removal

Insertion. A pacemaker may be implanted whilst a person is awake using local anesthetic to numb the skin with or without sedation, or asleep using a general anesthetic. An antibiotic is usually given to reduce the risk of infection. Pacemakers are generally implanted in the front of the chest in the region of the left or right shoulder The anesthesia provider should be involved in the flow of the case and should wear a headset if used by the rest of the team. If GA is performed, paralysis may or may not be desired

Permanent pacemakers are used to treat various bradycardic arrhythmias and are implanted during a short surgical procedure, usually under local anesthesia. The electronic control center of the pacemaker is called the pulse generator , which is encased in titanium with a lithium iodide battery inside that lasts 5-12 years Catheters: The cordis is a 6 french catheter that comes with an dilator and guidewire.You will still need a triple lumen and accessory kit for all of the miscellaneous pieces (sutures, scalpel, needles, etc). There is a single side port (that can be used for medication administrator or blood draws) that should be flushed with saline

Sedation in the Electrophysiology Laboratory: A

Older adults have fewer pacemaker cells in the SA node which increases the risk for dysrhythmia. ( Ignatavicius et al, 2016, p 656) Pacemaker implant is a surgical intervention done to enable the SA node to work normally and is used to treat conduction disorders. Pacemakers can last 10-20 years Sixteen consecutive adult patients scheduled for permanent transvenous cardiac pacemaker insertion received as their total anesthetic the combination of a cervical plexus block and blocks of the second, third, and fourth intercostal nerves using a combination of 1% mepivacaine and 0.2% tetracaine with epinephrine, 1:200,000 Temporary. Pacemaker leads are attached directly to the heart during open-heart surgery. Wires run externally through the chest incision and can be attached to an external impulse generator if needed. It is commonly used during and immediately following open-heart surgery. Endocardial (transvenous) Pacemaker

Pacemaker implantation - How it's performed - NH

Light intravenous sedation with midazolam and fentanyl is usually adequate for modern low-energy lithotripsy. Deeper sedation with low-dose propofol infusions with or without midazolam and opioid supplementation may also be used. F. Monitoring. Standard anesthesia monitoring must be used for conscious or deep sedation, or for general anesthesia What will happen during a pacemaker insertion? You may be given IV sedation to make you feel calm and relaxed during the procedure. You may also be given local anesthesia to numb the procedure area. With local anesthesia, you may still feel pressure or pushing, but you should not feel any pain

Pacemaker - Mayo Clini

  1. Central Line bundle to be performed prior to line insertion: Operator Hand Hygiene: Alcohol-based hand rub Soap and water Assistant Hand Hygiene: Alcohol-based hand rub Soap and water Skin Prep: Chlorhexidine/alcohol (CHG) - Check Which Process Used Below: Dry surgical site: 30 sec. scrub & 30 sec. dry tim
  2. - What a pacemaker generator and pacemaker leads look like. - Where the pacemaker generator will be implanted. - Use of general anesthesia or conscious sedation during procedure. - Details of the usual preoperative preparation. Nurse Role ( Post-procedure care):-1- Immediate post-procedure care . 2- Caution and precaution
  3. Pacemaker Device Insertion >332512 = insertion or replacement of pacemaker pulse generator only, single chamber, atrial or ventricular >33213 = dual chamber (Epicardial placement of the electrode should be report separately; use 33202/33203 in conjunction with 33212/33213 as, appropriate
  4. Excessive alcohol use leads to elevated levels of triglycerides or stored fat in the blood as well as an increase in blood pressure, according to the American Heart Association. Some patients fitted with a pacemaker due to an underlying cardiac arrhythmia might be better abstaining entirely, though on a case-by-case basis, a doctor may still.
  5. g the device. An example of a surgical procedure reported with anesthesia code 00530 is CPT code 33208 - Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular
  6. Pacemakers can be used to treat a variety of bradyarrhythmias in veterinary patients, most commonly third degree AV block, followed by sick sinus syndrome, high grade second degree AV block, and atrial standstill. Pacemakers are more commonly placed in canine patients, but have been placed in cats and ferrets
  7. Anesthesia for permanent transvenous pacemaker insertion in 75-year-old patient with ESRD. This is a moribund patient who is not expected to survive without this operation. An anesthesiologist provided anesthesia. Assign the CPT anesthesia code with appropriate CPT physical status and HCPCS level II anesthesiologist modifiers

Permanent Pacemaker Insertion Periprocedural Care

  1. Anesthesia HCPCS Modifier - used to indicate certain deep, complex, complicated or markedly invasive surgical procedures. This modifier is to be applied to the following anesthesia CPT codes only: 00100, 00300, 00400, 00160, 00532 and 00920. G
  2. Causes of Intra-operative Pacemaker Failure . Generator failure (e.g. battery, malfunction) Lead failure (e.g. dislodgement) Failure to capture. Acid-base imbalance . Electrolyte abnormality . Ischemia/infarction . Antiarrhytmics (overdose or withdrawal) Pacemaker Insertion Complications . Pneumothorax. Arterial puncture. Arrhythmia. Venous air.
  3. Use of the pacemaker in the ICU by Yanick Beaulieu MD, FRCPC Pacemaker in the ICU Plan - Sedation / analgesia as needed. 8 Transcutaneous cardiac pacing use fluoroscopy • Blind insertion should be done with soft, flow-directed catheter with inflatable balloo

Permanent Pacemaker Insertion Technique: Approach

  1. Use of temporary pacing wire before implantation 2.46 (1.09 to 5.13) Pre-discharge re-intervention (eg, for clot evacuation, lead but if sedation is used at all, it is often simply given in the theatre itself. Most PPMs are to perform a venogram if there is difficulty in obtaining venous access during pacemaker implantation
  2. Just as with the original procedure, you will be given a sedative to relax you and the insertion and removal site will be numbed. During the procedure, the doctor may also elect to replace one or more of the leads that deliver electrical impulses to the heart. In general, replacement procedures take less time than initial pacemaker implantation
  3. These codes include the insertion of the pulse generator subcutaneously, the transvenous placement of the electrode or electrodes, and moderate (conscious) sedation. If, during the insertion process, the skin pocket requires revision, this is also included in these codes (and all others from 33206-33249)
  4. After a pacemaker insertion, you will need to keep regular appointments to ensure the pacemaker is working the way it should. The healthcare provider uses a special computer, called a programmer, to review the pacemaker's activity and adjust the settings when needed. A remote monitor may also be used to allow the pacemaker to be checked at your.

Heart Pacemaker Surgery: What to Expect Before, During

  1. or discomfort when the local anaesthetic is injected. There are risks with any procedure, but the risks are low with pacemaker insertion. About 1 in 100 people experience serious complications during.
  2. d possible issues with magnet
  3. Provide the anesthesia code for insertion of a permanent single-chamber pacemaker. 00530. Qualifying circumstance add-on codes are not considered modifiers. True. Use of +99100 with 00834 is the correct way to code for a hernia repair for an 11-month-old child. False
  4. ations (LCDs) and Articles LCD Article Contractor Medicare Part A Medicare Part

An implanted pacemaker is used to support the slow heart rate and medicine is usually given to control the fast heart rhythms. Post-catheter ablation Pacemakers are also used following a procedure called catheter ablation that involves applying radiofrequency (similar to a microwave) energy to the A The medication used to induce anesthesia is called an anesthetic. The main types of anesthesia include: Procedural sedation: Commonly used outside of an operating room setting, procedural sedation provides a depressed level of consciousness so that a patient can tolerate unpleasant procedures without affecting cardiovascular function and.

On the other hand, if the anesthesia practitioner performed general anesthesia reported as CPT code 01382 and at the request of the operating physician inserted an epidural catheter for treatment of anticipated postoperative pain, the anesthesia practitioner may report CPT code 62326-59 or XU, or 62327- 59 or XU indicating that this is a. The biventricular pacemaker is currently used in the treatment of congestive heart failure. Learn more about cardiac resynchronization therapy here. Pacemaker Insertion Process. Generally, a pacemaker insertion follows this process: Patients will receive some sedation intravenously to help with relaxation during the procedure

The Advisa™ MRI SureScan™ pacemaker is the second-generation FDA-approved pacing system designed for safe use in the MRI environment when specific conditions are met. Advisa is available in single and dual chamber options. Model numbers: A2DR01, A3SR0 People with pacemakers can continue their usual sexual activity. Remember your pacemaker when you arrive at the airport or other public places with security screening. Metal detectors won't damage your pacemaker, but they may detect the metal in your device. At the airport, let the TSA agent know that you have a pacemaker pacemaker. A pacemaker is a small, metal, battery-powered We will offer you sedation if you would like to have this, which will make you feel relaxed and sleepy. This often requires no treatment but may require the insertion of a chest drain, to help reinflate the lung There are two different kinds of devices: pacemakers and defibrillators. Pacemakers are used to treat slow rhythm problems, and defibrillators are used to treat fast rhythm problems coming from the bottom part of the heart. Devices are placed under conscious sedation. You do not need a general anesthetic for the procedure

Procedural sedation for adult patients: an overview BJA

Fitting the pacemaker. The most widely used method to fit a pacemaker or an implantable cardioverter defibrillator (ICD) is known as transvenous implantation. Transvenous implantation. In transvenous implantation, the wires of the pacemaker (pacing leads) are inserted into your heart through a vein The Tula System ear tube delivery system for treatment of recurrent ear infections for children age 6 months and older and adults in a physician's office setting under local anesthesia The right IJ is generally the most preferred as it saves the left subclavian for a permanent pacer. The left IJ or right subclavian can also be used. However, these approaches require the catheter to go through a tortuous course and make an acute angle turn respectively, making these more difficult locations for blind insertion The response can be programed, therefore some pacemakers will have no response and some will pace asynchronously. The magnet effect must be confirmed prior to any operative procedure when possible. Battery life can affect the response to magnet application. If the battery is low, the pacemaker will pace at lower rates and may be inadequate

Pacemaker (PM) and/or implantable cardioverter

A Complete Regional Anesthesia Technique for Cardiac Pacemaker Insertion Syed M. Raza, MD, Appa Rao Vasireddy, MD, Kenneth D. Candido, MD, Alon P. Winnie, MD, and Robert W. Masters, MD Sixteen consecutive adult patients scheduled for permanent transvenous cardiac pacemaker insertion received as their total anesthetic the combination of a cervical plexus block and blocks of the second, third. Dual chamber pacemakers stimulate both the right atrium and the right ventricle. The implantation procedure is typically performed under local anesthesia and requires only a brief hospitalization. A catheter is inserted into the chest and the pacemaker's leads are threaded through the catheter to the appropriate chamber(s) of the heart Pacemaker - Insertion of Leads or Catheters: From the pacemaker code, 00530/4 units in 2016, the insertion or replacement of pacemaker electrodes or pacing catheters have crossed to the central venous access code 00532/4 units. Service code AA modifier is used for anesthesia services personally performed by an anesthesiologist. The. A pacemaker is a tiny device (not more than the size of a small matchbox), placed in the chest or abdomen, that sends small electrical impulses to the heart muscles for maintaining a suitable heart rate. It may also be used to treat heart failure, fainting spells (), and certain diseases of the heart muscles (hypertrophic cardiomyopathy).. The commonest use of pacemakers, however, is the. The installation of a pacemaker takes place under local anesthesia and takes about 2-3 hours. The technique of the operation depends on the type of implantable device. The single-chamber ones are the fastest installed, the situation with three and four-chamber models is much more complicated and longer

Permanent Pacemaker: Treatment, Prevention, Outloo

Best answers. 0. Dec 7, 2009. #4. Hello, The correct codes to bill are 33208 (dual chamber/lead pacemaker) & 71090-26 ( fluoroscopy guidance) You cannot bill for the accessing the L upper extremity vessel or axillary vein, this is included in the placement of the leads/pacemaker. Hope this helps. Dolores, CPC-CCC. Last edited: Dec 7, 2009 A pacemaker is a small device about the size of a matchbox or smaller that weighs 20 to 50g. It consists of a pulse generator, which has a battery and a tiny computer circuit, and 1 or more wires known as pacing leads, which attach to your heart. The pulse generator emits electrical impulses through the wires to your heart Local anesthetic will be used to numb the area. Sedation and pain medication will be given through your intravenous (IV) catheter to make you comfortable. A small incision is usually made on the left side of the chest, where the device will sense the heart rhythm. The device is placed under the skin. The device will be sutured in place The Halyard Health Pacemaker Drape is designed specifically to meet your needs during pacemaker and defibrillation insertion procedures performed in the Electrophysiology Lab (E.P. Lab) or in the Operating Room. The Pacemaker Drape's extended length -- 135 inches, top to bottom -- makes it ideal for the longer tables used in the E.P. Lab Patients will receive some sedation intravenously to help with relaxation during the procedure. The doctor will give a local anesthetic to numb the skin and tissue at the site of the pacemaker implantation. After the area is numb, the doctor will guide the leads through the vein and into the heart's right-side chambers using fluoroscopy (X-ray.

Anesthesia for carotid stent procedure

Involuntary muscle contraction caused by extracardiac stimulation is a rare complication induced by a pacemaker. We report a case who developed sudden onset diaphragmatic contractions during general anesthesia caused by a DDD mode pacemaker. A 74-year-old woman with a permanent pacemaker was scheduled to undergo mastectomy. The pacing mode was switched from DDD to VOO intraoperatively to avoid. During this procedure, I administered moderate conscious sedation using midazolam and fentanyl (totals for each documented in chart.) I was assisted in monitoring the patient's level of consciousness, blood pressure, heart rate, arterial saturation, and respiratory rate by an independent, critical care nurse as documented in the chart Chapter 32 Pacemaker Insertion, Revision, and Extraction Mark H. Schoenfeld It would be too ambitious an undertaking to address in a single chapter such diverse pacemaker themes as implantation, revision, and extraction. This chapter, however, presents the author's personal perspective on the subject(s). The goal is to provide information that is readable for clinicians an The anesthesia provider must also appreciate the pharmacokinetic and pharmacodynamic variability of propofol, especially when used in combination with other drugs (such as short-acting opioids). As a result, a patient with a seemingly adequate dose can be still awake, and a patient with a smaller dose can be apneic, be unresponsive, and require.