**5. Anesthesia considerations in patients undergoing PPM and ICD implantation**

#### **5.1 Pre-anesthesia care**

The electrophysiology laboratory (EP lab) should be equipped with the following: anesthesia machine, air mask bag unit (patient-ventilator), electrocardiogram (ECG or EKG), pulse oximetry, defibrillators, emergency trolley, suction machine, external pacing equipment, capnography, airway management equipment. Moreover, emergency medications, including dantrolene for malignant hyperthermia, intralipid for toxicity due to local anesthetics, and antidotes drugs (naloxone, neostigmine, sugammadex, flumazenil), resuscitation drugs (epinephrine, atropine), anesthetics (propofol, etomidate), sedatives (midazolam), analgesics (fentanyl), antiarrhythmic drugs, and inotropes should be available. In addition to inspecting and preparing the equipment, an experienced and trained staff (including an anesthetic team who are sufficiently skilled in resuscitation) should be present. All patients seeking pacemaker and ICD implantation require preoperative evaluations, including (ECG), chest radiograph, blood tests (complete blood count and differentiation, BUN, CR, PT, PTT, INR), and electrolyte levels (K, Na, Ca) (**Figure 2**).

**Figure 2.** *Instrument setup for lead implantation based on Seldinger technique.*
