Preoperative assessment: pacemaker and diathermy: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Preoperative assessment: pacemaker and diathermy

Sample item

A pacemaker-dependent patient with a permanent pacemaker is scheduled for an abdominal operation, and monopolar diathermy will be used. Electromagnetic interference may inhibit pacing. Which plan is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Use short bursts or bipolar diathermy, place the return plate away from the chest, and have a magnet or programmer available for asynchronous pacing

Diathermy can be sensed as cardiac activity and inhibit pacing. Bipolar or short bursts, a return plate positioned so that current does not pass across the generator, pulse monitoring and a magnet or programmer for asynchronous pacing reduce the risk. A pacemaker-dependent patient must never be left without pacing.

Option by option

  • A. Use short bursts or bipolar diathermy, place the return plate away from the chest, and have a magnet or programmer available for asynchronous pacing (correct)

    Correct. Limiting interference and having a way to give asynchronous pacing protects a dependent patient.

  • B. Use long continuous bursts of monopolar current with the return plate on the chest wall

    Long bursts with the plate near the chest maximise interference with the generator.

  • C. Use monopolar diathermy freely, since modern pacemakers are immune to interference

    Pacemakers can still be inhibited or reset by diathermy current.

  • D. Switch the pacemaker off with a programmer, since the patient will have an adequate escape rhythm

    A pacemaker-dependent patient has no reliable escape rhythm, so switching it off is dangerous.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Use short bursts or bipolar diathermy, place the return plate away from the chest, and have a magnet or programmer available for asynchronous pacing. Diathermy can be sensed as cardiac activity and inhibit pacing.

Why is "Use long continuous bursts of monopolar current with the return plate…" not the answer?

Long bursts with the plate near the chest maximise interference with the generator.

Why is "Use monopolar diathermy freely, since modern pacemakers are immune to…" not the answer?

Pacemakers can still be inhibited or reset by diathermy current.

Why is "Switch the pacemaker off with a programmer, since the patient will ha…" not the answer?

A pacemaker-dependent patient has no reliable escape rhythm, so switching it off is dangerous.

What concept does this question test?

It tests Preoperative assessment: pacemaker and diathermy in Anaesthesia. Bipolar or short bursts, a return plate positioned so that current does not pass across the generator, pulse monitoring and a magnet or programmer for asynchronous pacing reduce the risk. A pacemaker-dependent patient must never be left without pacing.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Preoperative assessment: pacemaker and diathermy?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.