Key result
Structured perioperative planning facilitates safe major surgery in a frail patient with an outdated pacemaker.
Why the study?
Anaesthesia in patients with permanent pacemakers poses unique challenges, particularly in frail patients undergoing major oncological surgeries, requiring perioperative planning to avoid adverse cardiovascular outcomes.
Structured perioperative planning and timely device interrogation are crucial for the safe anaesthetic management of frail patients with permanent pacemakers undergoing major surgery.
May warrant device interrogation before major surgery in frail pacemaker patients; extends evidence for structured perioperative protocols.
Anaesthesia in patients with permanent pacemakers (PPMs) poses unique challenges, especially in frail patients undergoing major oncological surgeries. Adequate perioperative planning is crucial for avoiding adverse cardiovascular outcomes. We report successful perioperative management of a frail patient with an outdated PPM who underwent low anterior resection and anastomosis for carcinoma rectum in a low-resource environment. Written informed consent was obtained from the patient for publication of this case report. This case emphasises the importance of timely device interrogation and structured perioperative planning, particularly in frail patients with PPMs. The proposed ‘PACE-SAFE’ mnemonic provides a practical and structured approach for anaesthesiologists to manage these high-risk patients, even in resource-limited settings. Regular patient education and structured follow-up systems are key to ensuring long-term device functionality and patient safety.
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Sharma et al. (2026) studied this question. The successful perioperative management of a frail patient with an outdated permanent pacemaker during major surgery highlights the importance of structured planning.
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