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Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome
- Source :
- Anesthesia, Essays and Researches
- Publication Year :
- 2015
- Publisher :
- Medknow Publications & Media Pvt Ltd, 2015.
-
Abstract
- 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 2(nd) 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.
- Subjects :
- medicine.medical_specialty
business.industry
medicine.medical_treatment
asymptomatic sick sinus syndrome
Case Report
right ventricular outflow tract temporary pacing
medicine.disease
Asymptomatic
Anesthetic management
Sick sinus syndrome
Surgery
Transvenous pacing
Prone position
medicine.anatomical_structure
Anesthesia
Materials Chemistry
medicine
Ventricular outflow tract
medicine.symptom
business
Percutaneous nephrolithotomy
Ventricular dyssynchrony
Sinus (anatomy)
Subjects
Details
- Language :
- English
- ISSN :
- 22297685 and 02591162
- Volume :
- 9
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Anesthesia, Essays and Researches
- Accession number :
- edsair.doi.dedup.....e18e33fa5b9ae42cbaa18f464451b636