Permanent Pacemaker Insertion Medication

Updated: May 21, 2014
  • Author: Chakri Yarlagadda, MD, FACC, FSCAI, FASNC, CCDS; Chief Editor: Richard A Lange, MD, MBA  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Antibiotics, Other

Class Summary

Routinely, cefazolin 1 g is administered intravenously (IV) 1 hour before the procedure. If the patient is allergic to penicillins or cephalosporins, vancomycin 1 g IV or another appropriate antibiotic may be administered preoperatively.

Cefazolin

Cefazolin is a first-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth.

Vancomycin

Vancomycin is a potent antibiotic that is directed against gram-positive organisms and that is active against Enterococcus species. It is useful in the treatment of septicemia and skin structure infections. Vancomycin is indicated for patients who cannot receive or have not responded to penicillins and cephalosporins and for patients who have infections with resistant staphylococci.

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Local Anesthetics, Amides

Class Summary

Local anesthetics block the initiation and conduction of nerve impulses.Anesthetics used for the permanent pacemaker insertion include bupivacaine and lidocaine.

Bupivacaine (Marcaine)

Bupivacaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.

Lidocaine (Xylocaine)

Lidocaine is an amide local anesthetic used in 1-2% concentration. The 1% preparation contains 10 mg of lidocaine for each 1 mL of solution; the 2% preparation contains 20 mg of lidocaine for each 1 mL of solution. Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels.

To improve local anesthetic injection, cool the skin with ethyl chloride before injection. Use smaller-gauge needles (eg, 27 gauge or 30 gauge). Make sure the solution is at body temperature. Infiltrate very slowly to minimize the pain. The time from administration to onset of action is 2-5 minutes, and the effect lasts for 1.5-2 hours.

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