Anaesthetic management of two patients with pacemaker in-situ posted for herniorrhaphy

Background: Patients with cardiac disease presenting for surgery pose a considerable challenge to the anaesthesiologist. Even patients belonging to geriatric and pediatric age group are detected to have electrophysiological disorders. Pacemakers are being used with greater frequency for both conduction and arrhythmia problems in such patients. Although no definite figures are available, the number of patients with pacemaker coming for anaesthesia and surgery is increasing now a days. Case of pacemaker during surgery as well as understanding its anesthetic implications is crucial in management of these patients. The growing use of pacemakers increases the likelihood that the anaesthesiologist will be often required to manage anaesthesia for a patient with an implanted pacemaker. Case report: 1) Here we present a case of anaesthetic implication of 61 year old male patient with pacemaker insitu diagnosed as left sided indirect inguinal hernia posted for herniorraphy which was managed under subarachanoid block. Pacemaker was inserted 5 yrs back. On examination pulse 86 per minute, BP 140/90 mm of Hg. CVS/RS normal. ECG: Rate- 70 with pacemaker spikes with LBBB. 2) Anaesthetic implications of 6 years old male child with pacemaker insitu diagnosed as right congenital hernia posted for herniorraphy managed under general anaesthesia. Pacemaker was inserted 3 years back. Intense monitoring for rhythm changes were done, other measures to decrease interference of pacemaker with perioperative events were considered. Bradycardia Management. Intravenous pacing was kept ready. Conclusion: Perioperative goal in management of patient with pacemaker . Minimum interference with pacemaker. Manage pacemaker failure.