Most preoperatively discovered complete heart block cases without cardiac clearance in a non-emergent situation are managed with deferral of elective surgery until a cardiology workup can be completed. The medical consequences of surgical delays can manifest in increased costs to the healthcare system via the treatment of more advanced disease, often requiring more intense and more costly treatment in addition to the emotional burden of delay on a patient that has been waiting months for a particular surgery. Delays in surgery have real impacts on patient health outcomes, hospital finances, and patient satisfaction. We present a rare case in which a proactive anesthesiologist was able to take measures to stratify patient safety risk and safely prevent the delay of the surgery in an asymptomatic and unfollowed congenital third-degree heart block patient. The anesthesiologist demonstrates the use of established guidelines for non-elective noncardiac surgery to safely and effectively prevent the delay of an elective inguinal hernia repair in the setting of a situation that normally warrants its delay. Using these pre- and intraoperative measures, the anesthesiologist was able to prevent the delay of elective surgery, and this should set a precedent of the necessary steps involved to safely manage a patient with an unfollowed third-degree congenital heart block.
case report, congenital complete heart block, metabolic equivalents, preoperative assessment and risk management, temporary pacemaker
Varkoly KS, Beladi RN, Ritrosky S. Elective Inguinal Hernia Surgery in the Setting of Unfollowed Congenital Complete Heart Block With No Postponement. Cureus. 2020; 12(10). doi: 10.7759/cureus.10865.