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Nag K, Nagella AB, Kumar VR, et al. Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome. Anesth Essays Res. 2015;9(3):423-6doi: 10.4103/0259-1162.159770.
Nag, K., Nagella, A. B., Kumar, V. R., Singh, D. R., & Ravishankar, M. (2015). Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome. Anesthesia, essays and researches, 9(3), 423-6. https://doi.org/10.4103/0259-1162.159770
Nag, Kusha, et al. "Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome." Anesthesia, essays and researches vol. 9,3 (2015): 423-6. doi: https://doi.org/10.4103/0259-1162.159770
Nag K, Nagella AB, Kumar VR, Singh DR, Ravishankar M. Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome. Anesth Essays Res. 2015 Sep-Dec;9(3):423-6. doi: 10.4103/0259-1162.159770. PMID: 26712989; PMCID: PMC4683470.
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Anesth Essays Res. 2015 Sep-Dec;9(3):423-6. doi: 10.4103/0259-1162.159770.

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

Anesthesia, essays and researches

Kusha Nag, Amrutha Bindu Nagella, V R Hemanth Kumar, Dewan Roshan Singh, M Ravishankar

Affiliations

  1. Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India.

PMID: 26712989 PMCID: PMC4683470 DOI: 10.4103/0259-1162.159770

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.

Keywords: Anesthetic management; asymptomatic sick sinus syndrome; right ventricular outflow tract temporary pacing

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