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Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy with dual-chamber pacemaker undergoing transurethral resection of the prostate


Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India

Correspondence Address:
Amit Jain
Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.69043

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Year : 2010  |  Volume : 13  |  Issue : 3  |  Page : 246-248

 

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We describe the anesthetic management of a patient with hypertrophic obstructive cardiomyopathy with dual-chamber pacemaker undergoing transurethral resection of the prostate. Anesthetic challenges included prevention and management of perioperative arrhythmias, maintenance of adequate preload, afterload and heart rate to relieve left ventricular outflow tract obstruction and considerations related to the presence of dual-chamber pacemaker and TURP. We recommend preoperative reprogramming of the DDD pacemaker, avoidance of magnet application during the procedure, application of electrosurgical unit current returning pad to the anterior aspect of the thigh, especially if monopolar cautery is used, use of central venous pressure line for estimation of preload and careful titration of anesthetic drugs to maintain stable hemodynamics.






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Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh, India

Correspondence Address:
Amit Jain
Department of Anaesthesia & Intensive Care, Post Graduate Institute of Medical Education & Research, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.69043

Rights and Permissions

We describe the anesthetic management of a patient with hypertrophic obstructive cardiomyopathy with dual-chamber pacemaker undergoing transurethral resection of the prostate. Anesthetic challenges included prevention and management of perioperative arrhythmias, maintenance of adequate preload, afterload and heart rate to relieve left ventricular outflow tract obstruction and considerations related to the presence of dual-chamber pacemaker and TURP. We recommend preoperative reprogramming of the DDD pacemaker, avoidance of magnet application during the procedure, application of electrosurgical unit current returning pad to the anterior aspect of the thigh, especially if monopolar cautery is used, use of central venous pressure line for estimation of preload and careful titration of anesthetic drugs to maintain stable hemodynamics.






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