Journal of Anesthesiology and Pain

Abstract: Background and Aim: Since electrocardiography (ECG) is essential for the diagnosis of pediatric asymptomatic Complete Heart Block (CHB) and it is not usually done in the preoperative evaluation of asymptomatic children, physicians might confront with asymptomatic cases of CHB at anesthesia induction. Case Report: In this study, we introduced a 31-month-old boy who faced CHB after anesthesia induction. The mentioned 15-kg-weighted child who had got involved in bradycardia after the induction of anesthesia for renal anti-reflex surgical procedure. Anesthesia was reversed after diagnosis of CHB and emergency cardiology consultation was performed and referred to pediatric cardiac ICU for further evaluation. In the primary ECG, atrial and ventricular beats were 150 and 70 rhythms, respectively, and ventricular complexes were also narrow. A temporary transcutaneous cardiac pacemaker was placed and a normal echocardiography was detected. After the preparation of Angiography Unit, he was provided with a temporary intravenous pacing. A 24-hour Holter Monitoring with the underlying heart rate of 40 bpm was implemented for the patient as an indication of his CHB with an average heart rate of 90 bpm. No other positive finding was obtained. Regarding lack of the patient's improvement after several days, his probable congenital CHB was posed. Subsequently, the patient with a intravenous temporary pacemaker was referred to the referral hospital for surgical procedure and then readmitted at ICU. Two days after the surgery, his pacemaker was removed and he was discharged and recommended for follow-up visits Since anesthetic drugs can intensify bradycardia, preparation of chemical pacemaker, temporary pacemaker, and a skilled physician for their utilization in case of confrontation with such undiagnosed problems is necessary. Moreover, for instances of diagnosed cases, pacemakers should be positioned before commencing anesthesia induction after confirmation of their proper performance.