journal of medical science and clinical research | 2019
Peri-Operative Challenges in Patients with Complete Heart Block with Varied Cardiac Pacemakers and Implantable Cardiac Defibrillators
Abstract
The indications for CIEDs (Cardiac pacemakers and implantable cardiac defibrillators) in the general population is increasing worldwide. Patients with CIEDs presenting for a non cardiac surgery is on the rise. It is the Anaesthesiologist’s duty to be well versed and take adequate perioperative care of the patients with CIEDs presenting for non cardiac surgeries. Here we present a case of 67 year old female with Carcinoma stomach with PPI insitu posted for subtotal gastrectomy. Introduction Artificial pacemakers are generally indicated for the treatment of symptomatic bradycardia of any origin (1) . The spectrum of indications for permanent pacing is on a steady rise along with the technological advancements with respect to pacemakers rises parallely. Some of the specific indications include sick sinus syndrome, chronic bifascicular block, long QT syndrome etc.. (2) . With respect to internal cardiac defibrillators (ICDs) the latest advancement has significantly reduced the complications and widened the spectrum of indications also. When a patient with CIEDs presents for a non cardiac surgery, the intraoperative environment provides several opportunities to disturb proper functioning of the device. In addition the other comorbidities of the patient serves as an additional challenge for the Anaesthesiologist. Case Report A 67 year old female weighing 60 kg presented to SGE OP department with pain abdomen associated with vomiting for past 3 months. UGI scopy revealed an ulceroproliferative growth in fundus of stomach for which subtotal gastrectomy was planned after biopsy confirmation as malignancy. The patient had a permanent pacemaker placed 10 years ago for symptomatic bradycardia with complete heart block. On the day before surgery pacemaker technician from the concerned company (Medtronics) was called to evaluate the working condition of the pacemaker. There was no intrinsic rhythm checked by applying magnet. Rate responsiveness was deactivated by applying programme. Preoperative night patient was premedicated with tablet Ranitidine 150mg and tablet Diazepam 5 mg. www.jmscr.igmpublication.org Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.177