On the day of the surgery, pacemaker interrogation was done by the company representative. Pacemaker device visible on chest radiogram Chest X-ray confirmed the position of the pacemaker with the impulse generator. The pacemaker was scheduled to be reprogrammed to asynchronous VOO mode before the surgery. The pacemaker had a battery life of 1.25 to 9 years capture: 6.0 v at 0.8 msec impedance: 597-ohm and percentage of ventricular pacing: 1.1% (signifying negligible patient dependence on the pacemaker). A 2D echocardiography revealed an ejection fraction of 60%. A 12 lead electrocardiography (ECG) had normal sinus rhythm with no paced beats (rate of 85/min). Specialist cardiology consultation was done. Effort tolerance and routine investigations were normal. The last surgery was done as an emergency 6 months back during which there was a history of temporary pacemaker insertion peri-operatively. Transurethral bladder surgery had been done two times in the past uneventfully under spinal anaesthesia. In past medical history, there were four cycles of chemotherapy and also a history suggestive of heart block (details of the type of heart block or the specific indication were not available) for which a permanent pacemaker (PPI- VVIR- ST JUDE) was implanted 9 years ago. A 69-year-old male patient weighing 55 kg with a diagnosis of muscle-invasive urinary bladder carcinoma was scheduled for radical cystectomy with ileal conduit under general anaesthesia.
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