Pre Op Surgery Visit

I’m scheduled to have my thyroid gland removed on October 31st (Halloween) and have a pre-op visit on October 10th. Since I’m 100% paced with a dual chamber pacemaker, I’ve been told there are some concerns about the effects of the anesthesia on my heart.

Another concern is the use of the electronic knife (electrocautery) during surgery, as it will be close to my pacemaker leads. To address this, the hospital is bringing in another surgeon and my cardiac doctor for additional support.

I’m looking for advice on the types of questions I should ask during my pre-op meeting. The involvement of additional medical support and my cardiac doctor has me a bit concerned. If anyone has had a similar experience, I’d love to hear about it.

2 Comments

You seem to have a strong team looking after you

by Gemita - 2024-09-22 04:23:06

Stache, 

Firstly the involvement of additional medical support for your procedure should only bring reassurance.  I know your doctors have discussed your case carefully in a multi-disciplinary team meeting and have put everything in place for a good, safe outcome.  It is reassuring to know that you will have all the medical people present with expertise in their own field to watch over you during your delicate procedure.

I have had several general anaesthetics both prior to and after my pacemaker implant.  Arrhythmia control was always my main concern.  During my pre op clinics, I was always reminded that anaesthetics and all surgery can have a wide range of effects on the body, particularly on the cardiovascular system.   Cardiac depression and hemodynamic instability is possible and the signs and symptoms of these stresses can be “masked” by anaesthesia which is why we have expert teams monitoring us throughout our procedures to try to keep us safe.  

You could ask what safeguards have been put in place in the event of say a drop in blood pressure through blood loss, management of any hypothermia, of any arrhythmias and things like this?  I know you experienced a cardiac arrest this year during a pacemaker check when your device was turned off, so this clearly will be on the minds of your medical teams.  You could also ask them to confirm the dose and anaesthetic agent that will likely be used during the procedure;  also the process of intubation to secure your airways and any difficulties this might cause during delicate thyroid surgery?   

I expect your doctors have clearly asked each other how to address all the potential difficulties that could arise during your procedure.  You could perhaps ask them what their main concerns actually were for a patient like you with heart block, if you haven’t already done so, and what specific safeguards have been put in place should these difficulties develop?  Have you received a letter giving you all the possible risks and benefits involved with the thyroid surgery?  

I believe your device will be placed in a safe mode prior to surgery and that you will be paced at a fixed, higher heart rate for the duration of the procedure.  You could ask more questions about this, although you will have a cardiac technician on hand throughout this period.

I see your pre-op appointment is on my birthday, so I won't forget it.  I do hope you will get complete reassurance on the 10th that you can "safely" move forward towards your all important procedure and that it will be a success in all respects.

Concern

by piglet22 - 2024-09-22 05:43:46

I don't think you should be too concerned.

It's almost inconceivable that the surgeon would not take into account your cardiac problems, though if it isn't brought up in the conversation, it's worth a mention.

The cover of my now thick medical record paperwork has a large red label on it saying NO DIATHERMY. Hopefully that has been transcribed to the digital version..

The dentist is more concerned than the medics I occasionally see and one consultant put several thousand volts up my left arm without any words of reassurance 

Pacemakers have been around for long enough for any problems with other procedures to have come to light and be part of any protocol.

It sounds as though other specialities are aware which is good to hear.

I hope all goes well 

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