Perioperative Management of a Permanent Pacemaker During Elective Inguinal Hernioplasty Under Spinal Anaesthesia: A...

Patients with cardiac implantable electronic devices (CIEDs) are increasingly presenting for non-cardiac surgery, requiring careful perioperative planning to avoid electromagnetic interference, device malfunction, and haemodynamic instability. Although general anaesthesia is frequently used in such patients, regional anaesthesia may offer several advantages when appropriately selected. We report the successful perioperative management of a 75-year-old man with coronary artery disease and a VVIR permanent pacemaker who underwent elective Lichtenstein hernioplasty under spinal anaesthesia. Following a multidisciplinary evaluation, the pacemaker was temporarily converted to asynchronous VOO pacing using magnet application. Continuous electrocardiographic monitoring, avoidance of monopolar electrocautery, availability of external defibrillation, and perioperative cardiology support ensured a safe perioperative period. The intraoperative and postoperative periods were uneventful. This case highlights the importance of structured CIED assessment, individualised pacemaker management, and careful haemodynamic monitoring when neuraxial anaesthesia is considered in patients with permanent pacemakers.