General anesthesia for a patient with asymptomatic sick sinus syndrome
Nakamura, S.; Nishiyama, T.; Hanaoka, K.
Masui. Japanese Journal of Anesthesiology 54(8): 912-913
2005
ISSN/ISBN: 0021-4892 PMID: 16104550 Document Number: 593805
A 67-year-old man with glioblastoma was scheduled for craniotomy. Before anesthesia induction, asymptomatic bradycardia (40 beats (.) min(-1)) occurred, and was resistant to atropine 0.4 mg. The surgery was postponed. He was diagnosed as sick sinus syndrome (sinus arrest). He received implantation of a temporary cardiac pacemaker on the day before the rescheduled surgery. Anesthesia was induced with thiopental 400 mg, fentanyl 200 mu g, vecuronium 10 mg and isoflurane 5%, and maintained with isoflurane 1-2% in oxygen 3 l (.) min(-1) and air 3 l (.) min(-1). Pacing mode was set to fixed rate asynchronous pacing in the ventricle with a rate of 50 beats (.) min(-1) after anesthesia induction. Surgery was completed in 8 hours and 45 minutes without any complications. The pacing wire was removed the next day.For patients with sick sinus syndrome, implantation of the pacemaker is indicated in case of bradycardia-tachycardia syndrome or with any clinical symptoms. However, a pacemaker should be implanted before general anesthesia even in a patient with no clinical symptoms because of cardiovascular instability induced by anesthesia.