Skip to main content
SpringerLink
Log in

Effect of General Anesthesia on the Defibrillation Energy Requirement in Patients Undergoing Defibrillator Implantation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background: The effect of general anesthesia on defibrillation efficacy in humans is not known. The purpose of this study was to determine the effect of general anesthesia on the defibrillation energy requirements in patients undergoing implantation of a pectoral defibrillator.

Methods and Results: Nineteen consecutive patients who underwent defibrillator implantation under general anesthesia were prospectively compared to 16 consecutive patients who underwent defibrillator implantation by the same physicians, using similar devices, at another hospital under conscious sedation. Pre-discharge testing was performed 1.4 ± 1.0 days after implant using sedation in both groups. The defibrillation energy requirement was determined using the same predefined step-down protocol (15, 10, 8, 5, 3, 1 J) at the time of implantation and during pre-discharge testing. The clinical characteristics of the patients were similar between groups. There was no significant difference in the mean implant defibrillation energy requirement compared to the mean pre-discharge defibrillation energy requirement in either the general anesthesia group (8.5 ± 4.7 vs. 8.4 ± 3.4 J; p = 0.9) or in the conscious sedation group (9.4 ± 3.9 vs. 9.0 ± 3.8 J; p = 0.7).

Conclusions: When compared to conscious sedation, general anesthesia with mechanical ventilation has no significant effect on defibrillation efficacy in patients undergoing defibrillator implantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Strickberger SA, Hummel JD, Daoud E, et al. Implantation by electrophysiologists of 100 consecutive cardioverter defibrillators with nonthoracotomy lead systems. Circulation 1994;90:868–872.

    Google Scholar 

  2. Fitzpatrick AP, Lesh MD, Epstein LM, et al. Electrophysiological laboratory, electrophysiologist-implanted, nonthoracotomy-implantable cardioverter/defibrillators. Circulation 1994;89:2503–2508.

    Google Scholar 

  3. Pacifico A, Cedillo-Salazar FR, Nasir N Jr, et al. Conscious sedation with combined hypnotic agents for implantation of implantable cardioverter-defibrillators. J Am Coll Cardiol 1997;30:769–773.

    Google Scholar 

  4. Lipscomb KJ, Linker NJ, Fitzpatrick AP. Subpectoral implantation of a cardioverter defibrillator under local anaesthesia. Heart 1998;79:253–255.

    Google Scholar 

  5. Van Rugge FP, Savalle LH, Schalij MJ. Subcutaneous single-incision implantation of cardioverter-defibrillators under local anesthesia by electrophysiologists in the electrophysiology laboratory. Am J Cardiol 1998;81:302–305.

    Google Scholar 

  6. Keelan ET, Sra JS, Axtell K, et al. The effect of polarity of the initial phase of a biphasic shock waveform on the defibrillation threshold of pectorally implanted defibrillators. Pacing Clin Electrophysiol 1997;20:337–342.

    Google Scholar 

  7. Strickberger SA, Man KC, Daoud E, et al. Effect of firstphase polarity of biphasic shocks on defibrillation threshold with a single transvenous lead system. J Am Coll Cardiol 1995;2:1605–8.

    Google Scholar 

  8. Trappe HJ, Pfitzner P, Fain E, et al. Transvenous defibrillation leads: is there an ideal position of the defibrillation anode? Pacing Clin Electrophysiol 1997;20:880–892.

    Google Scholar 

  9. Schwartzman D, Callans DJ, Gottlieb CD, et al. Early postoperative rise in defibrillation threshold in patients with nonthoracotomy defibrillation lead systems: Attenuation with biphasic shock waveforms. J Cardiovasc Electrophysiol 1996;7:483–493.

    Google Scholar 

  10. Goldberger JJ, Horvath G, Inbar S, Kadish AH. Utility of predischarge and one-month transvenous implantable defibrillator tests. Am J Cardiol 1997;79:822–826.

    Google Scholar 

  11. Olsovsky MR, Pelini MA, Shorofsky SR, Gold MR. Temporal stability of defibrillation thresholds with an active pectoral lead system. J Cardiovasc Electrophysiol 1998;9:240–244.

    Google Scholar 

  12. Hatakeyama N, Ito Y, Momose Y. Effects of sevo_urane, iso_urane, and halothane on mechanical and electrophysiologic properties of canine myocardium. Anesthesia & Analgesia 1993;76:1327–1332.

    Google Scholar 

  13. Stowe DF, Bosnjak ZJ, Kampine JP. Comparison of etomidate, ketamine, midazolam, propofol, and thiopental on function and metabolism of isolated hearts. Anesthesia & Analgesia 1992;74:547–558.

    Google Scholar 

  14. Pharand C, Goldman R, Fan C, et al. Effect of chronic oral moricizine and intravenous epinephrine on ventricular fibrillation and defibrillation thresholds. Pacing Clini Electrophysiol 1996;9:82–89.

    Google Scholar 

  15. Von Knobelsdorff G, Goerig M, Nagele H, Scholz J. Interaction of frequency-adaptive pacemakers and anesthetic management. Discussion of current literature and two case reports. Anaesthesist 1996;45:856–860.

    Google Scholar 

  16. Cohen TJ, Lowenkron DD. The effects of pneumothorax on defibrillation thresholds during pectoral implantation of an active can implantable cardioverter defibrillator Pacing Clin Electrophysiol 1998;21:468–470.

    Google Scholar 

  17. Gill RM, Sweeney RJ, Reid PR. The defibrillation threshold: a comparison of anesthetics and measurement methods. Pacing Clin Electrophysiol 1993;16:708–714.

    Google Scholar 

  18. Babbs CF. Effect of pentobarbital anesthesia on ventricular defibrillation threshold in dogs. Am Heart J 1978;95: 331–337.

    Google Scholar 

  19. Echt DS, Black JN, Barbey JT, et al. Evaluation of antiarrhythmic drugs on defibrillation energy requirements in dogs. Circulation 1989;79:1106–1117.

    Google Scholar 

  20. Natale A, Jones DL, Kim Y-H, Klein GJ. Effects of lidocaine on defibrillation threshold in the pig: evidence of anesthesia related increase. Pacing Clin Electrophysiol 1991;14: 1239–44.

    Google Scholar 

  21. Dorian P, Fain ES, Davy J-M, Winkle RA. Lidocaine causes a reversible, concentration-dependent increase in defibrillation energy requirements. J Am Coll Cardiol 1986;8: 327–332.

    Google Scholar 

  22. Ujhelyi MR, Sims JJ, Miller AW. High-dose lidocaine does not affect defibrillation efficacy: implications for defibrillation mechanisms. Am J Physiology1998;274:H1113–1120.

    Google Scholar 

  23. Echt DS, Gremillion ST, Lee JT, et al. Effects of procainamide and lidocaine on defibrillation energy requirements in patients receiving implantable cardioverter defibrillator devices. J Cardiovasc Electrophysiol 1994;5:752–760.

    Google Scholar 

  24. Nelson SD, Lenhart MB, Saffarin A. The influence of sodium channel blockade on the defibrillation energy requirements of biphasic versus monophasic shocks. Pacing Clin Electrophysiol 1996;19:1568–1573.

    Google Scholar 

  25. Winecoff-Miller AP, Sims JJ, McSwain R, Ujhelyi MR. Lidocaine' effect on defibrillation threshold are dependent on the defibrillation electrode system: Epicardial versus endocardial. J Cardiovasc Electrophysiol 1998;9:312–320.

    Google Scholar 

  26. Horton RP, Canby RC, Roman CA, et al. Determinants of nonthoracotomy biphasic defibrillation. PACE 1997;20: 60–64.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI

    Bradley P. Knight, Frank Pelosi, Matthew Flemming, Fred Morady & S. Adam Strickberger

  2. Oakwood Hospitals, Dearborn, MI

    Bradley P. Knight, Frank Pelosi, Matthew Flemming, Fred Morady & S. Adam Strickberger

Authors
  1. Bradley P. Knight
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frank Pelosi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew Flemming
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fred Morady
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Adam Strickberger
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Knight, B.P., Pelosi, F., Flemming, M. et al. Effect of General Anesthesia on the Defibrillation Energy Requirement in Patients Undergoing Defibrillator Implantation. J Interv Card Electrophysiol 3, 325–328 (1999). https://doi.org/10.1023/A:1009831802964

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1009831802964

Search

Navigation