# Emergency Neurosurgery in a Patient With Pacemaker: The Double Trouble

## TL;DR

This case report discusses the challenges of managing a patient with a pacemaker undergoing emergency neurosurgery for a stroke.

## Contribution

The paper presents a real-world example of perioperative management in a patient with a pacemaker and acute stroke.

## Key findings

- Emergency neurosurgery was performed on a patient with a pacemaker due to intracerebral hemorrhage.
- Preoperative pacemaker settings could not be changed due to lack of equipment and trained personnel.
- Intraoperative precautions were taken to prevent pacemaker-related complications.

## Abstract

Perioperative management of a patient with multiple comorbidities, being taken up for an emergency neurosurgical procedure presents a unique set of challenges to the anesthetist as it requires quick preoperative evaluation in order to avoid any delay in the surgery and limit the extent of cerebral injury. This case report highlights the perioperative management of a 55-year-old obese male patient, with a history of hypertension and coronary artery disease with a permanent pacemaker presenting to the emergency with weakness of right upper and lower limbs, suggestive of an acute stroke due to intracerebral hemorrhage. The patient was taken up for emergency decompressive craniectomy in view of increasing intracranial pressure and deteriorating consciousness. The pacemaker could not be changed to asynchronous mode in the preoperative period due to the non-availability of a magnet and trained personnel from the company of the pacemaker to change the settings immediately. Intraoperatively, all the necessary precautions for the prevention of pacemaker-related complications were followed. After the completion of the surgery, the patient was shifted to the neuro-intensive care unit for postoperative management.