Cardiac pacing is one of the most reliable treatment for most arrhythmias. Patient with permanent pacemaker & underlying pathogenisis leading to their implantation presents considerable challenge to anaesthesiologists. These patients are unable to react to situation requiring increased cardiac output. Pacemaker can also be affected by electromagnetic interference during surgery

A 84 year old female presented with fracture neck of femur was posted for hemiarthroplasty. She had undergone VVI type of pacemaker for 30 AV block 4 years back. She also known hypertensive and had severe kyphosis & distal thoracic aorta aneurysm. Lumbar epidural anaesthesia at the level of L2 –L3 interspace was given and catheter was fixed at 8cm. electro cautrey was avoided

nil

Anticipating hemodynamic changes & intraoperative electromagnetic interference and hence adopting suitable technique is prudent. We emphasize the need for vigilance and meticulous preparation in the anaesthetic management of such cases