Medication Summary

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

Class Summary

Routinely, cefazolin 1 g (or 25 mg/kg) is administered intravenously (IV) 1 hour before the procedure. If the patient is allergic to penicillins or cephalosporins, vancomycin 1 g IV, clindamycin 600 mg IV, or another appropriate antibiotic may be administered preoperatively.

Cefazolin

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

Vancomycin

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Vancomycin is a potent antibiotic that is directed against gram-positive organisms and that is active against Enterococcus species. 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.

Clindamycin (Cleocin, Cleocin Pediatric, ClindaMax Vaginal)

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Clindamycin is an antibiotic that interrupts protein synthesis and is active against gram-positive organisms, including most methicillin-resistant Staphylococcus aureus (MRSA) strains. Clindamycin can be used as an alternative to vancomycin in penicillin-allergic patients.

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)

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

Lidocaine (Xylocaine)

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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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Media Gallery

This electrocardiogram reveals a sinus atrial mechanism with complete atrioventricular block and a ventricular paced rhythm.
This electrocardiogram illustrates third-degree atrioventricular block in a 2-year-old child.
This electrocardiogram illustrates an atrial-synchronous, ventricular paced rhythm.
The normal cardiac conduction system is illustrated. AV = atrioventricular, IVC = inferior vena cava, SA = sinoatrial, SVC = superior vena cava.
This radiograph depicts a transvenous ventricular pacemaker in 2-year-old child. Note the abundant slack in the lead to allow for growth.
An epicardial dual-chamber implantable cardioverter defibrillator is shown in a neonate with congenital complete atrioventricular block. Two bipolar suture-on leads (one on the atrium and one on the ventricle) are attached to the DDDR pacemaker in the abdomen.

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Author

Bradley C Clark, MD Advanced Fellowship in Pediatric Electrophysiology, Children’s National Health System; Clinical Instructor in Pediatrics, George Washington University School of Medicine and Health Sciences

Bradley C Clark, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic<br/>Received research grant from: Medtronic.

Coauthor(s)

Charles I Berul, MD Professor of Pediatrics and Integrative Systems Biology, George Washington University School of Medicine; Chief, Division of Cardiology, Children's National Medical Center

Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD Executive Director of The Heart Center, Interim Division Chief of Pediatric Cardiology, Lurie Childrens Hospital; Professor, Department of Pediatrics, Northwestern University, The Feinberg School of Medicine

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Acknowledgements

John W Moore, MD, MPH Professor of Clinical Pediatrics, Section of Pediatric Cardiology, Department of Pediatrics, University of California San Diego School of Medicine; Director of Cardiology, Rady Children's Hospital

John W Moore, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, Cardiac Electrophysiology Society, New York Academy of Sciences, Society for Pediatric Research,Texas Medical Association, and Texas Pediatric Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Pediatric Pacemaker Implantation Medication

Medication Summary

Antibiotics, Other