裝有植入式心臟去顫器的病人接受下頷腺切除手術全身麻醉的病例報告

General Anesthesia for Patients with Automatic Implantable Cardioverter Defibrillator in Place-- A Case Report

植入式心臟去顫器在1985年由美國FDA核准上市，用來治療在心室頻脈及心室震顫的病人身上有良好的功效。每年使用率都在增加。臺灣衛生署在1997年准許在台使用植入式心臟去顫器，健保局在2002年12月核准在醫學中心實施植入式心臟去顫器，准予給付。將來麻醉醫師遇到裝有植入式心臟去顫器來實施手術的機率會越來越高。手術前評估，麻醉方式及術後照護對麻醉醫師都是一項挑戰。本文報告一位72歲裝有植入式心臟去顫器的病人，實施下頷腺切除手術，在全身麻醉下，順利完成手術，沒有任何併發症產生。對於此類病人，手術前心率不整的有效控制，手術前後對植入式心臟去顫器的正確處理，評估可以有效降低併發症的產生。

Automatic implantable cardioverter defibrillator (AICD) was commercially available for use in patients with malignant ventricular tachycardia and ventricular fibrillation since its meeting with FDA approval in 1985. The number of AICD implantation has increased year by year worldwide. It was allowed to be used in clinical setting in Taiwan by the Department of Health in April 1997. Physicians may come across patients with an implanted AICD undergoing surgery unrelated to cardiac issues more frequently. It is also a new challenge to anesthesiologists who must make pre-operative evaluation, maintenance during operative period and post-operative re-evaluation of the AICD function. We bring forward here for discussion a 72-year-old male patient who underwent non-cardiac surgery with AICD implantation under general anesthesia. The anesthetic precautions of patients with the device are also touched.