Special anaesthesia: ICD 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 · Special anaesthesia: ICD and diathermy

Sample item

A 64-year-old man with an implantable cardioverter-defibrillator (ICD) is scheduled for open cholecystectomy with monopolar diathermy. What is the appropriate perioperative management?

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

The answer and the reasoning

A. Suspend tachyarrhythmia therapy (by magnet or reprogramming) and keep external defibrillation pads in place

Electromagnetic interference from monopolar diathermy near the umbilicus or above can be misread as ventricular fibrillation and trigger an inappropriate shock. Tachyarrhythmia detection is therefore suspended by magnet or reprogramming, with external pads applied in case of a real arrhythmia. A magnet over an ICD disables shock therapy but does not change the pacing mode.

Option by option

  • A. Suspend tachyarrhythmia therapy (by magnet or reprogramming) and keep external defibrillation pads in place (correct)

    Correct. Suspending therapy prevents inappropriate shocks, and pads allow rescue defibrillation.

  • B. Place a magnet over the device and expect it to switch to fixed-rate pacing

    A magnet suspends ICD shocks but does not produce asynchronous pacing, unlike a pacemaker.

  • C. Cancel surgery because monopolar diathermy is contraindicated in all ICD patients

    Surgery can proceed safely when the device is managed appropriately.

  • D. Leave the device active because diathermy cannot affect an ICD

    Diathermy interference can cause inappropriate discharges or inhibit pacing.

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, Suspend tachyarrhythmia therapy (by magnet or reprogramming) and keep external defibrillation pads in place. Electromagnetic interference from monopolar diathermy near the umbilicus or above can be misread as ventricular fibrillation and trigger an inappropriate shock.

Why is "Place a magnet over the device and expect it to switch to fixed-rate…" not the answer?

A magnet suspends ICD shocks but does not produce asynchronous pacing, unlike a pacemaker.

Why is "Cancel surgery because monopolar diathermy is contraindicated in all…" not the answer?

Surgery can proceed safely when the device is managed appropriately.

Why is "Leave the device active because diathermy cannot affect an ICD" not the answer?

Diathermy interference can cause inappropriate discharges or inhibit pacing.

What concept does this question test?

It tests Special anaesthesia: ICD and diathermy in Anaesthesia. Tachyarrhythmia detection is therefore suspended by magnet or reprogramming, with external pads applied in case of a real arrhythmia. A magnet over an ICD disables shock therapy but does not change the pacing mode.

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 Special anaesthesia: ICD 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.