Abstract
We report our experience administering general anesthesia to a pediatric patient with a pacemaker because of polysplenia syndrome. A six-year-old girl weighing 16 kg underwent extirpation of a submandibular sialolith under general anesthesia. The pacemaker mode was AAIR, and the lower heart rate was set at 90 beats/min. The infusion of acetated Ringer’s solution was started 2 hours prior to the operation. Before anesthesia induction, the pacing mode was changed to AAI. Sevoflurane in oxygen was administered for anesthesia induction, and nasotracheal intubation was performed. Anesthesia was maintained with fentanyl and sevoflurane in oxygen. A monopolar electric surgical scalpel was used for the operation, and the reference electrode was subsequently fixed on the scapula, away from the abdominal pacemaker. As a result, anesthesia was managed without electromagnetic interference.
Polysplenia syndrome is characterized by left atrial isomerism and bilateral left sidedness of visceral organs. In addition, it presents with bradyarrhythmias, such as sinus node dysfunction and/or complete atrioventricular block, and it is associated with the interruption of the inferior vena cava accompanied by azygos continuation. In the present patient, the preoperative infusion of acetated Ringer’s solution and early ambulation were attempted to avoid thrombosis arising from the hypovolemic condition. In cases with polysplenia syndrome, the possibility of perioperative deep vein thrombosis requires careful attention.
