Anaesthetic management of a patient with sick sinus syndrome for exploratory laparotomy

Alex, Sunny; Saneesh, J.P.; Rao, Rammoorthi; Upadya, Madhusudan

doi:10.1080/22201173.2010.10872713

Cited by 2 publications

(9 citation statements)

References 15 publications

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“…described a case of sick sinus syndrome for exploratory laparotomy in which failure of efficient transcutaneous pacing on operating table warranted the need of immediate insertion of the transvenous temporary pacemaker. [ 9 ] In diagnosed, asymptomatic patients preoperative insertion of a temporary pacemaker has been recommended because anesthesia as such or surgical maneuvers may induce serious dysrhythmias resistant to conventional pharmacological treatment. [ 10 ] Although our patient was asymptomatic, a well-documented sinus pause on ECG and unresponsiveness to atropine warranted the need for instituting temporary pacing preoperatively as prone position during surgery prevents access to transvenous pacing if required.…”

Section: Discussionmentioning

confidence: 99%

Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome

et al. 2015

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A 60-year-old woman posted for percutaneous nephrolithotomy with ureterolithotripsy was found to have a history of hypertension and ischemic heart disease from past 6 months on regular treatment. Pulse rate was irregularly irregular in a range of 56–60/min, unresponsive to atropine, with a sinus pause on the electrocardiogram. Although the patient was asymptomatic, anticipating unmasking of the sick sinus syndrome during general anesthesia in the prone position, a temporary pacemaker was implanted at right ventricular outflow tract (RVOT) septum before the scheduled surgery. A balanced anesthesia technique with endotracheal intubation was administered. There were several episodes of continuous pacing by the temporary pacemaker intraoperatively, which may be attributed to unmasking of the sinus node dysfunction due to general anesthesia. At the end of surgery, patient was extubated after adequate reversal from neuromuscular blockade. Postoperative period remained uneventful, and the pacemaker wires were removed on the 2nd postoperative day. With this case report, we highlight the importance of inserting a temporary pacemaker prior to anesthesia even in an asymptomatic patient if a sinus node dysfunction is suspected preoperatively and if intraoperative access to transvenous pacing is difficult such as in prone position. Pacing at RVOT septum minimizes ventricular dyssynchrony and improves hemodynamic parameters.

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Section: Discussionmentioning

confidence: 99%

Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome

et al. 2015

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“…Therefore, the anesthesia technique need to be adjusted based on the patients' clinical condition. 2,4,9,[12][13][14]22 In general anesthesia, narcotics and inhalational agents can be used safely for patients with PPM. However, for patients with bradycardia, high dosage of fentanyl and dexmedetomidine must be avoided, because it will increase cardiac dependency towards PPM by altering PPM electrical trigger and stimulation threshold.…”

Section: Intraoperativementioning

confidence: 99%

“…This infiltration will cause the accidental removal of anode lead from pacing generator. 2,4,9,[12][13][14]22 The other agents which should also be avoided for patients with PPM are succinylcholine, etomidate, and ketamine, because they can trigger fasciculation or myoclonus which can interrupt the function of PPM. Succinylcholine can still be given for rapid sequence induction (RSI) on condition that premedication of nondepolarized muscle relaxation must be performed first in order to achieve de-fasciculation.…”

Section: Intraoperativementioning

confidence: 99%

“…Besides those agents, the usage of methadone, haloperidol, ondansetron as well as high dosage of anesthetic inhalation should be avoided towards patients with prolonged QT interval syndrome, because it can increase the risk of polymorphic ventricular tachycardia. 2,4,9,[12][13][14]22 Neuraxial anesthesia is the first choice for patients with PPM, especially for ones with co-existing cardiovascular diseases, because it has less effects on their physiology and enables fast recovery. Nevertheless, it is important to pay attention to the patients' clinical condition, the estimated duration of surgery, the convenience of the surgeons.…”

Section: Intraoperativementioning

confidence: 99%

“…Therefore, the function and the integration of PPM, must always be evaluated before and after performing those procedures. 2,4,9,[12][13][14]22 Regarding intraoperative monitoring, ASA standardized monitoring devices must always be available and applied before induction. This includes ECG monitor, pulse oximetry (with plethysmograph), and noninvasive blood pressure (NIBP).…”

Section: Intraoperativementioning

confidence: 99%

See 2 more Smart Citations

Cardiac Patients for Non-Cardiac Surgery: Anesthetic Considerations in Patients with Permanent Pacemaker

Oktavia¹

2020

IJC

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Permanent pacemaker (PPM) are being used in greater frequency in managing patients with electrophysiology disorders. These patients can be presented for either cardiac or non-cardiac surgery after their device implantation. They also will undergo either general or regional anesthesia to facilitate the surgical procedure. As an anesthesiologist, understanding patientsâ€™ condition, pacemaker care and safe anesthetic technique of choice are very important to provide safe patient management. Therefore, this literature reviewed and summarized a systematic approach which can be followed in managing these patients. Various approach and guidelines have been discussed in the literature on how to manage patients with PPM who will undergo anesthesia. In this literature, the American Society of Anesthesiology (ASA) standard was used as a framework for managing patients with PPM. Meanwhile, the decision of anesthesia technique that being chosen should be based on patientsâ€™ clinical condition, the surgical procedure itself, the duration of surgery, and the convenience of the surgeon. Overall, patients with PPM require special attention in perioperative management. Both anticipations of the patientâ€™s condition and the performance of PPM must always be considered to provide safe anesthesia practice.

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Anaesthetic management of a patient with sick sinus syndrome for exploratory laparotomy

Cited by 2 publications

References 15 publications

Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome

Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome

Cardiac Patients for Non-Cardiac Surgery: Anesthetic Considerations in Patients with Permanent Pacemaker

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