Resident wrote:I don't get a lot of patients with pacemakers, but have never considered a
pacemaker a contraindication to the use of electrocautery. We don't have an
alternative, except laser which I haven't used since residency. Pardon my
ignorance, but am I committing a grave error?
Not really, but as in any surgical endeavor, you should make sure that you
can handle the complications should they arise. In the case of pacemakers,
particularly those with unipolar leads, the cautery can inhibit the
pacemaker output. If the pacemaker battery is near the end of its life,
the pacemaker can be permanently inhibited or forced into a different mode.
You should therefore make sure you have access to the requisite programmer
for the patient's pacemaker, and I would recommend that you also have a
defibrillator pack that contains an external transcutaneous pacemaker in
the OR just in case. Of course, you should never use monopolar cautery
near a pacemaker lead, since the radio frequency cautery energy can induce
a current in the pacemaker lead sufficient to cause ventricular
fibrillation. Bipolar cautery is safer, but even this can induce enough
current in the lead to affect pacemaker operation.