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.

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Aniruth Geethchand

Post Graduate, Department of Anaesthesiology and Critical Care, CHRI