Anesthetic Management of Patient with Sick Sinus Syndrome during General

Anesthesia for Emergency Herniotomy : a Case Report

Andri Subiantoro*, Nasrullah*, Pesta Parulian M Edwar**, Bambang Pudjo Semedi**, Arie
Utariani**

* Resident, Department of Anesthesiology & Reanimation Dr. Soetomo General Hospital

Surabaya, Indonesia

** Consultant, Department of Anesthesiology & Reanimation Dr. Soetomo General Hospital

Surabaya, Indonesia

Abstract

Sick sinus syndrome (SSS) is a generalized abnormality of cardiac impulse formation that
may be caused either by an intrinsic disease of the sinus node, which makes it unable to perform
its pacemaking function, or by extrinsic factors.1,2 Patients with SSS occasionally need temporary
pacing during general anesthesia.1 We report a case of a 52-year-old man who required temporary
cardiac pacing during herniotomy with general anesthesia. A 52-year-old man who weighed 50
kg was admitted with a history of right lower abdominal pain and a provisional diagnosis of
strangulated inguinal hernia was made. A emergency herniotomy was planned. The pre
anaesthetic examination showed that blood pressure was 160/100 mmHg and pulse rate was
irregularly irregular with a range of 4256/minute. An ECG showed bradycardia (50 bpm) and
irregular rate. A chest X-ray was cardiomegaly (CTR 70 %). The patients left ventricular
function was decline with an ejection fraction of 40 %. In view this condition, a cardiological
evaluation was done. The cardiologist determined to need for a temporary pacing during general
anesthesia. The anaesthetic technique was general endotracheal anaesthesia, keeping
transcutaneous pacing on standby. Temporary pacing is most commonly used to treat
symptomatic bradycardia for short periods.2 In diagnosed asymptomatic patients without an
implanted pacemaker, preoperative insertion of a transvenous temporary pacemaker has been
recommended, because anaesthesia or surgical manoeuvres may induce serious dysrhythmia,
resistant to conventional pharmacological treatment.2,3 We suggest that temporary transvenous
pacing, are useful for this condition perioperatively, particularly for abdominal procedures.1,2

Keywords : General Anesthesia, Sick Sinus Syndrome, Temporary Pacemaker

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