Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1997
Perioperative management of children with third degree heart block undergoing pacemaker placement: a ten year review.
It has been suggested that children with third degree heart block require insertion of a temporary pacemaker prior to general anaesthesia. This recommendation needs to be reevaluated with the availability of noninvasive transcutaneous cardiac pacing. We undertook a retrospective ten-year chart review of anaesthesia in children with third degree heart block undergoing pacemaker insertion or revision. ⋯ In children who were not being paced, 60% had baseline heart rates less than 60 bpm. Complications seen in this study, including hypotension, would not have been prevented by temporary pacemaker placement. We conclude that there is no benefit to routine preoperative temporary pacing in children with third degree heart block.
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Continuous monitoring of heart rate and rhythm are regarded as minimal standards of monitoring during anaesthesia. However, when the thoracic area is exposed for surgery as for debridement of burns and split skin grafting then placement of surface electrodes for electrocardiographic (ECG) monitoring is not possible. We report the intraoperative use of an old technique, oesophageal ECG (OesECG) in a child presenting for major burns surgery. The positioning of the probe, electrical safety and P-QRS morphology, are discussed.