Creator: Dr. Kiran Kumar Kolla Gopalkrishna
Published: 2018-02-19T12:30:24-04:00

Patient's Query

Hello doctor,

I am 60 years male. I have a BMI of 33. I have bifascicular bundle block. I take Salbutamol and Fluticasone (Relvar) puffers for asthma, which is lifelong. I have seen my GP and my cardiologist and been cleared for bariatric (gastric band) surgery next week, in order to expedite some weight loss, as my asthma has prevented me from much exercise. However, I am nervous about the anesthesia given my bundle block and I am here seeking informed discussion and expert counsel. That is, I am here seeking a basic outline of what will be the anesthetist's approach, given bifascicular block. I am an academic and I have a reasonable understanding of basic medical issues as found in peer-reviewed articles which I have read via my university. But obviously, I lack the medical training to be able to figure out the anesthetic procedure and peri-operative risk by myself. I am making this inquiry so that I might discuss this with my anesthetist in a more informed way before I meet him tomorrow.

Answer

Dr. Kiran Kumar Kolla Gopalkrishna

Anesthesiology

Hello,

Welcome back to icliniq.com.

Bifasicular block is commonly RBBB (right bundle branch block) with left or right axis deviation. I need to explain to you that patients with this block are safe to undergo anesthesia. I would have been happy if an ECG was attached. If LBBB (left bundle branch block) is associated with the bifascicular block, only then the risk increases, which is complete heart block which needs a pacemaker.

In brief, there is no added risk due to bifascicular block. Please tell the anesthetist about this condition so that he keeps a temporary pacemaker ready if the need arises. There is just a 1 % chance of complete heart block.

For more information consult an anesthesiologist online --> https://www.icliniq.com/ask-a-doctor-online/anesthesiologist

Was this answer helpful?

Patient's Query

Dear doctor,

I would like to send you my most sincere gratitude for your prompt and excellent/precise reply. I value such clarity of communication in other professionals very deeply since it is a sine qua non of my position at the university. I have an ECG here somewhere, but since you say the anesthetist will not feel concerned or reluctant even if there is associated LBBB because he will have a temporary pacemaker ready in the unlikely case of complete heart block, I think you have answered my concern fully.

I am so impressed, I will be recommending your name to a colleague who has some concerns regarding anesthesia/surgery when I return after my surgery.

May I ask, in case something else comes to my mind today, for how long are you available until this evening or even perhaps tomorrow morning? Or is a phone call better? Please let me know. I wish you the very best and I look forward to hearing if you have availability tonight or tomorrow.