LAUSR

Her radial pulse rate was 80 beats/min, which was regularly irregular, and non-invasive blood pressure (NIBP) was 110/78 mmHg. Her systemic examination and investigations were within normal limits. Electrocardiogram (ECG) trace is shown in Figure 1. The 24-h Holter monitoring revealed frequent VPCs of right bundle-branch block morphology with superior axis, left bundle-branch block morphology (4% of total beats) with bigeminy and trigeminy. Two-dimensional echocardiography was suggestive of mild mitral regurgitation, mild tricuspid regurgitation and no regional wall-motion abnormality. with an ejection fraction of 60%. The patient was receiving oral propranolol 40 mg. We opted for single-shot SAB given the absence of any structural heart abnormality and short duration of surgery. Emergency resuscitation drugs and a charged defibrillator were kept ready. Preoperatively, oral diazepam 5 mg was used as anxiolytic. In the operation theatre, after placement of standard monitors and five‐lead ECG (Lead II and Lead V), the patient was given SAB in sitting position with 10 mg of bupivacaine (heavy) with 25 mcg of fentanyl and a sensory level up to T8 was achieved. The patient was positioned to lithotomy after drug fixation. Following SAB, the rhythm converted into normal sinus rhythm [Figure 2]. After 45 min, sensory level regressed to T10 and the rhythm again became irregular. The NIBP remained stable throughout the surgery. The duration of surgery lasted for 80 min, and the post-operative course was uneventful. Twelve‐lead ECG after 24 h was similar to the pre-operative ECG.