Perioperative Anaesthetic Management of a Patient with a Permanent Pacemaker Undergoing Low Anterior Resection for Carcinoma Rectum - A Case Report

Anaesthesia in patients with permanent pacemakers (PPMs) poses unique challenges, especially in frail patients undergoing major oncological surgeries. Adequate perioperative planning is crucial for avoiding adverse cardiovascular outcomes. We report successful perioperative management of a frail patient with an outdated PPM who underwent low anterior resection and anastomosis for carcinoma rectum in a low-resource environment. Written informed consent was obtained from the patient for publication of this case report. This case emphasises the importance of timely device interrogation and structured perioperative planning, particularly in frail patients with PPMs. The proposed ‘PACE-SAFE’ mnemonic provides a practical and structured approach for anaesthesiologists to manage these high-risk patients, even in resource-limited settings. Regular patient education and structured follow-up systems are key to ensuring long-term device functionality and patient safety.