Bradycardia during laparoscopic surgery due to high flow rate of CO<sub>2</sub>insufflation

Jung, Ki Tae; Kim, Sang Hun; Kim, Jae Wook; So, Keum Young

doi:10.4097/kjae.2013.65.3.276

Cited by 25 publications

(22 citation statements)

References 5 publications

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“…However, the CAG performed after the surgery revealed no explicit results. In terms of peritoneal stretching because of pneumoperitoneum, when the rate of CO 2 insufflation starts at a slow rate, it is unlikely that a vagus reflex would occur [8]. Moreover, in the present case, it is possible that if the CO 2 insufflation rate was increased over a longer period, then the excessive vagus reflex could have been avoided.…”

Section: Discussionmentioning

confidence: 73%

Temporary pacemaker insertion for severe bradycardia following pneumoperitoneum during robot-assisted radical prostatectomy: a case report

et al. 2020

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Background Pneumoperitoneum to maintain a constant gas flow to assist various surgeries is known to cause severe bradycardia and has been linked to heart failure;; however, a recent study demonstrated that it is not linked to poorer surgical outcomes; accordingly, it does not require routine preventive measures. Thus, whether there is a link between sudden bradycardia development and surgical procedures is controversial. We report the case of severe bradycardia that occurred along with a complete atrioventricular block (CAVB) during peritoneum creation in robot-assisted radical prostatectomy (RARP). Case presentation A 72-year-old man presented at our hospital with prostate cancer and underwent RARP. After pneumoperitoneum, severe bradycardia and CAVB were observed; thus, the surgery was extended by inserting a temporary pacemaker (TPM). Conclusion Because of the difficulty in performing emergency procedures in robot-assisted surgeries, the current case is reported to provide an awareness that surgeons should be cautious of the possible complication of bradycardia and CAVB during such operations, and thus should take steps necessary for managing induction of such conditions.

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Section: Discussionmentioning

confidence: 73%

Temporary pacemaker insertion for severe bradycardia following pneumoperitoneum during robot-assisted radical prostatectomy: a case report

et al. 2020

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“…Vagal bradycardia has been reported in many gynecological and general surgical cases. In gynecological cases, the onset of bradycardia was related to direct stretch and manipulation of the peritoneum; in other cases, it was related to the rate of CO 2 insufflation [14,17,18]. e high flow rate of CO 2 leads to rapid peritoneal stretch, causing a strong and fast vagal response [17].…”

Section: Discussionmentioning

confidence: 99%

Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation

Heyba

Khalil

Elkenany

2020

Case Reports in Anesthesiology

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Laparoscopy is becoming increasingly popular in gynecological and general surgical operations. There are complications that are inherent to the laparoscopy techniques; amongst them is intraoperative vagal-mediated bradycardia that results from peritoneal stretching. This can occur due to high flow rate of gas during peritoneal insufflation, a practice still happening nowadays. We report a case of a middle-aged hypertensive patient who was undergoing elective laparoscopic cholecystectomy. The patient was assessed more than once preoperatively by the anesthesia team for blood pressure optimization. The patient underwent general anesthesia and developed severe bradycardia immediately after peritoneal insufflation. The management started immediately by stopping the insufflation and deflating the abdomen. Afterwards, atropine was administered intravenously, and CPR was started preemptively according to the ACLS protocol to prevent the patient from progressing into cardiac arrest. She responded to the management and became vitally stable within one minute. After confirming that there was no cardiac or metabolic insult through rapid blood investigations and agreeing that the cause of bradycardia was the rapid insufflation, the surgical team proceeded with the surgery in the same setting using low flow rate of CO2 to achieve pneumoperitoneum. There were no complications in the second time and the operation was completed smoothly. The patient was extubated and shifted to the postanesthesia care unit to monitor her condition. The patient was stable and conscious and later shifted to the wards and discharged on routine follow-up after confirming that there were no complications in the postoperative follow-up. Therefore, it is important to monitor the flow rate of CO2 during peritoneal insufflation in laparoscopic surgery as rapid peritoneal stretch can cause severe bradycardia that might progress into cardiac arrest, especially in hypertensive patients. It is also important for the anesthetist to be vigilant and ready to manage such cases.

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“…Other reasons could be due to effect of negative intrapleural pressure on the right and left ventricles [9]. Role of Bezold-Jarish reflex could be another underlying mechanism [10].…”

Section: Review Of Literaturementioning

confidence: 99%

Bradycardia Secondary to Negative Suction Pressure Applied to Chest Drain

Arya¹,

Belwal²,

Saxena³

et al. 2019

CRCM

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Positive pressure generated in peritoneal cavity by gas insufflation during laparoscopic procedures can cause hemodynamic instability. There are a few case reports suggesting similar occurrences during thoracoscopic procedures as well. The mechanism behind the conditions above is explained to be due to stretch force applied to peritoneum and pleura which causes vagal stimulation. We wish to present a case where a high negative pressure applied to pleural cavity lead to treatment-resistant bradycardia. The possible mechanism behind this occurrence was traction pressure on pleura which triggered vagal activity. The bradycardia subsided on reducing or discontinuing negative suction pressure. To best of our knowledge this the first case report on bradycardia associated with high negative suction pressure applied to inter costal drain.

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Bradycardia during laparoscopic surgery due to high flow rate of CO₂insufflation

Cited by 25 publications

References 5 publications

Temporary pacemaker insertion for severe bradycardia following pneumoperitoneum during robot-assisted radical prostatectomy: a case report

Temporary pacemaker insertion for severe bradycardia following pneumoperitoneum during robot-assisted radical prostatectomy: a case report

Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation

Bradycardia Secondary to Negative Suction Pressure Applied to Chest Drain

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Bradycardia during laparoscopic surgery due to high flow rate of CO2insufflation

Cited by 25 publications

References 5 publications

Temporary pacemaker insertion for severe bradycardia following pneumoperitoneum during robot-assisted radical prostatectomy: a case report

Temporary pacemaker insertion for severe bradycardia following pneumoperitoneum during robot-assisted radical prostatectomy: a case report

Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation

Bradycardia Secondary to Negative Suction Pressure Applied to Chest Drain

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Bradycardia during laparoscopic surgery due to high flow rate of CO₂insufflation