Details
Category: Volume 08 Issue 11 November 2020
Hits: 1405

Title: Anaesthetic management of a patient with Sick Sinus Syndrome with pacemaker insitu for Urological procedure

Authors: Aniruth Geethchand, Hamse Nandinie

 DOI: https://dx.doi.org/10.18535/jmscr/v8i11.45

Abstract

Introduction

Sick sinus syndrome encompasses a heterogenous group of disturbances of cardiac rhythm related to sinus node dysfunction. The term ‘sick sinus’ to describe a condition in which chaotic atrial activity followed electrical cardio version. We report a case of 38year old male with sick sinus syndrome with pacemaker insitu to undergo surgery for right ureteric stone removal.

Case Report

A 38year old male with complaints of pain in the right loin region, vomiting and burning sensation while urination for three weeks and diagnosed to have right ureteric calculi and planned for right ureteroscopic lithotripsy with double J stenting. Patient is a known case of sick sinus syndrome with pacemaker insitu on VVI mode for 10 years. He is a known case of depressive disorder on T. Nexito 10mg and T. Lonazep 0.5mg on night. Patient also diagnosed to have Diabetes Mellitus and Dyslipedemia on T. Galvas 50 mg, T.Amaryl Mz and T.Rozuvas 10mg.Patient’s coronary angiogram showed slow flow in coronaries and normal epicardial coronary arteries. Basic investigations done and found within normal limits. ECG showed pacemaker rhythm. ECHO showed no regional wall motion abnormalities, PPI insitu, ejection fraction 60 percent and TRPG 21mmHg. Cardiac Opinion sought in view of pacemaker settings prior to surgery and was advised to change the pacemaker settings before surgery with the help of company person. After the consultation patient given fitness under ASA III. Patient pacemaker settings changed with the help of company person and patient shifted to operating room and vitals noted. Under aseptic precautions patient in sitting position using 25 G Quincke needle Spinal Anaesthesia was administered. Patient made supine immediately and oxygen given via facemask at 6l/min. After attaining level of T6, lithotomy done. During the procedure the patient Heart Rate (HR) maintained around 60 beats per minute and Mean Arterial Pressure (MAP) maintained above 60 and saturation is about 99 percent. Duration of the procedure lasted for one hour and patient shifted to the recovery room and vitals monitored. Pacemaker settings changed back to VVI mode and ECG taken showed pacemaker rhythm. Postoperative period was uneventful. Patient came for follow up after ten days and was doing well.

References

  1. BRAUNWALD E: Heart Disease, 2nd Philadelphia: WB Saunders, 1984, pp 693-694.
  2. HURST JW: The Heart, 6th New York: McGraw-Hill, 1986, pp 449-450.
  3. SHAW DB, KEKWICK CA. Potential candidates for pacemakers. Survey of heart block and sinoatrial disorder(sick sinus syndrome). British Medical Journal 1981; 40:99-105.
  4. MACKINTOSH AF. Sinoatrial disease in young people. British Heart Journal 1981; 45:62-6.
  5. RADFORD DJ, IZUKAWA T. Sick sinus syndrome: symptomatic cases in children. Archives of Disease in Childhood 1975; 50:879-885.
  6. ENCELTR, MEISTERSG, FEITOSAGS, FISCHER HA, FRAXKL WS. Appraisal of sinus node artery disease. Circulation 1975: 52: 286-91.
  7. MANDELWJ, HAYAKAWA H, ALLENHN, DANZIGR, KERMAIER AI. Assessment of sinus node function in patients with the sick sinus syndrome. Circulation 1972; 46: 761-9.
  8. CHIEN WW, FOSTER E, PHILLIPS B, SCHILLER N, GRIFFIN JC. Pacemaker syndrome in a patient with DDD pacemaker for long QT syndrome. Pacing Clin Electrophysiol1991;14: 1209-1212.
  9. BURT DER. The sick sinus syndrome. A complication during anaesthesia. Anaesthesia 1982; 37: 1108-11.
  10. HAYES DL, ZIPES DP. Cardiac pacemakers and cardioverter-defibrillator. In: Braunwald E, Heart Disease 6th edition, Philadelphia, WB Saunders, 2001; 7775-814.
  11. GREENE NM. Area of differential block in spinal anaesthesia with hyperbaric tetracaine. Anesthesiology 1958; 19:45-50.
  12. BURM AG, VAN KLEEF JW, GLADINES MP, SPIERDIJK J, BREIMER DD. Plasma concentrations of lidocaine and bupivacaine after subarachnoid administration. Anesthesiolgy 1983; 59:191-5.
  13. SEO, K., TAKAYAMA, H., ARAYA, Y., MIURA, K., TANAKA, Y., KOBAYASHI, Y. AND SOMEYA, G. (1996) Electromagnetic Interference of an External Temporary Pacemaker during Maxillofacial and Neck Surgery. Anesthesia Progress, 43, 64-66.
  14. LIU, J., YAO, G.E., ZHOU, H.D., JIANG, X.J. AND CHEN, Q. (2013) Prevention of Hemodynamic Instability in Extra-Cranial Carotid Angioplasty and Stenting Using Temporary Transvenous Cardiac Pacemaker. Cell Biochemistry and Biophysics, 65, 275-279.
  15. SHAW DB, HOLMAN RR, GOWERS JI. Survival in sinoatrial disorder (sick-sinus syndrome). British Medical Journal 1980; 280:139-41.
  16. American Society of Anesthesiologists (2011) Practice Advisory for the Perioperative Management of Patients with Cardiac Implantable Electronic Devices: Pacemakers and Implantable Cardioverter-Defibrillators: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Cardiac Implantable Electronic Devices. Anesthesiology, 114, 247-261.
  17. STONE, M.E., SALTER, B. AND FISCHER, A. (2011) Perioperative Management of Patients with Cardiac Implantable Electronic Devices. British Journal of Anaesthesia, 107, 116-126.
  18. Chakravarthy M, Prabhakumar D, George A. Anaesthetic consideration in patients with cardiac implantable electronic devices scheduled for surgery. Indian J Anaesth 2017; 61:736-43.
  19. Bryant H C,Roberts P R, Diprose P (2016) Perioperative management of patients with cardiac implantable electronic devices, BJA Education, 16 (11): 388–396.

Corresponding Author

Aniruth Geethchand

Post Graduate, Department of Anaesthesiology and Critical Care, CHRI