Reflex bradycardia during surgery

Doyle, D. John; Mark, Patrick

doi:10.1007/bf03005473

Cited by 106 publications

(68 citation statements)

References 40 publications

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“…Abdominal wall lifting techniques rapidly developed, since gasless laparoscopy has been firstly applied in cholecystectomy by Nagai in 1991 (1,5,6,24,27). These techniques provided a good visualisation for surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Gasless Laparoscopic Ovariohysterectomy and Comparison of Serum Levels of Interleukin-6 and C-Reactive Protein after Lohe and Traditional Laparoscopic Ovariohysterectomy in Bitches

Zhang

Jingtao

Liu

et al. 2013

Bulletin of the Veterinary Institute in Pulawy

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Ten mixed-breed female dogs were used in the study. Abdominal wall lifting was performed with a sterilised cotton strip. Four portal sites were used to complete gasless laparoscopic ovariohysterectomy (GLOHE) procedures. The proper and suspensor ligament, ovarian pedicle, and broad ligament of the uterus, uterine artery and vein were coagulated using bipolar electrocoagulation. After the uterine body was coagulated and cut, the end of the cervix was ligated with a loop suture. Blood samples were obtained before the surgery, immediately after the procedure, and on 1, 3, and 5 d postoperatively for the determination of interleukin-6 (IL-6) and C-reactive protein (CRP). No significant surgical complications occurred. After gasless laparoscopic ovariohysterectomy, a significantly higher serum IL-6 level was found immediately after the surgery and 1 d postoperatively when compared with the level observed after traditional laparoscopic ovariohysterectomy (LOHE). However, no significant differences were observed in CRP level between GLOHE and LOHE. GLOHE proved to be a safe and feasible procedure in bitches.

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Section: Discussionmentioning

confidence: 99%

Gasless Laparoscopic Ovariohysterectomy and Comparison of Serum Levels of Interleukin-6 and C-Reactive Protein after Lohe and Traditional Laparoscopic Ovariohysterectomy in Bitches

Zhang

Jingtao

Liu

et al. 2013

Bulletin of the Veterinary Institute in Pulawy

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“…1,10 The fact that reflex bradycardia usually occurs immediately after displacement of the liver, insertion of the hand into the peritoneal cavity, traction on the abdominal mesentery, placement of packing or retraction of wound edges provides clinical evidence for the afferent pathway. 1 -4 In general, reflex bradycardia is the result of a marked increase in cardiac vagal outflow, a decrease in sympathetic cardiac outflow or a combination of the two.…”

Section: Discussionmentioning

confidence: 99%

“…However, although anticholinergic prophylaxis has been shown to decrease the incidence of reflex bradycardia, the effect is not consistently reliable. 1,8 Additionally, anticholinergic premedication may give rise to tachycardia, which can be as harmful as bradycardia in patients with cardiovascular instability. Secondly, the results of the present study may not reflect the actual incidence of reflex bradycardia during gastrectomy because the observation period was limited to the first hour after the surgical incision.…”

Section: Discussionmentioning

confidence: 99%

“…1 It is usually shortlived and rapidly responds to relief of surgical traction or the administration of anticholinergic drugs. 1 Several studies, however, have reported critical bradycardia or asystole during gastrectomy, 2 colectomy 3 and cholecystectomy. 4 Bradycardia during abdominal surgery is thought to be caused by reflex vagal activity.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Desflurane and Sevoflurane Anaesthesia in Relation to the Risk of Vagally Mediated Reflex Bradycardia during Gastrectomy

Shin

et al. 2012

J Int Med Res

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OBJECTIVE: This study compared the risk of clinically significant reflex bradycardia during anaesthesia with sevoflurane or desflurane in patients undergoing gastrectomy. METHODS:In this randomized prospective study, 100 patients undergoing gastrectomy were assigned to receive sevoflurane (n = 50) or desflurane (n = 50) anaesthesia. No anticholinergic prophylaxis was administered. Symptomatic reflex bradycardia was defined as a sudden decrease in heart rate to < 50 beats/min, or a decrease to 50 -59 beats/min if associated with a systolic arterial pressure of ≤ 70 mmHg in response to surgical manoeuvres. If reflex bradycardia developed, atropine or ephedrine were administered according to a predefined treatment protocol. RESULTS: Data from 85 patients were available for analysis. The proportion of patients with symptomatic reflex bradycardia in the sevoflurane and desflurane groups was similar (69.0% versus 55.8%, respectively) and both groups required a similar amount of atropine and/or ephedrine. CONCLUSIONS: Clinically significant reflex bradycardia occurred with a relatively high frequency during gastrectomy. Although desflurane is associated with sympathetic activation, it did not provide a protective effect against vagally mediated reflex bradycardia during gastrectomy compared with sevoflurane.

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“…It is well known that bradycardia is induced by visceral manipulation during surgery in human [6,7]. And these responses have been considered as a reflex response whose efferent is the cardiac vagus nerve.…”

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confidence: 99%

Reflex Inhibition of Heart Rate and Efferent Cardiac Sympathetic Outflow Induced by Colorectal Distension in Anesthetized Rats

Suzuki²

2006

J. Physiol. Sci

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Colorectal distensions of 60 and 80 mmHg significantly reduced heart rate (HR) and cardiac sympathetic nerve activity in anesthetized rats. This bradycardiac response was not influenced by the intravenous administration of atropine, but was abolished by propranolol, suggesting that it was elicited by sympathetic but not vagal efferent nerves.Key words: colorectal distension, heart rate, cardiac sympathetic nerve activity.It has been reported that cardiovascular function is reflexively regulated by visceral noxious stimulation, such as distension of stomach [1], colorectum [2], biliary system [3], and uterus [4], in anesthetized animals. Our recent study demonstrated that a noxious range of colorectal distension (CRD) produced a reflexive decrease in blood pressure in anesthetized central nervous system (CNS)-intact rats via a reflexive inhibition of sympathetic vasoconstrictor nerve (renal sympathetic nerve) activity [5]. The decrease response of blood pressure induced by CRD in CNS-intact rats was reversed to increase response by spinalization at the 2nd cervical level (C2). Thus it was suggested that the reflex center of the CRD-induced inhibitory reflex modulation of blood pressure was at supraspinal levels in CNS-intact rats. There was also CRD-induced excitatory reflex modulation of blood pressure at the propriospinal levels, though the excitatory reflex was inhibited by the supraspinal structure in CNS-intact preparation [5].During these experiments on the blood pressure, we had observed that CRD produced bradycardia in association with a decrease in blood pressure in CNS-intact rats. It is well known that bradycardia is induced by visceral manipulation during surgery in human [6,7]. And these responses have been considered as a reflex response whose efferent is the cardiac vagus nerve. Using anesthetized rats, Grundy and Davison [8] suggested that the efferent path of bradycardia to a distension of the stomach was the cardiac vagus nerve. On the other hand, Robbins and Sato [4] reported that bradycardic responses to a distension of the uterus was not influenced by a bilateral vagotomy in anesthetized rats and suggested a contribution of the cardiac sympathetic nerve. It is interesting to learn the efferent paths and the reflex center of bradycardia induced by CRD.It has been reported that the cardiovascular response to CRD stimulation in anesthetized rats was unstable and fluctuated based on the depth of anesthesia [2]. Our previous study developed an anesthetized rat model of stable depressor response induced by CRD [5]. Using this rat model in the present study, we aimed to clarify the involvement of the cardiac sympathetic and parasympathetic nerves as efferent paths in the CRD-induced reflexive bradycardia. We also examined this reflex in spinalized rats to determine whether its reflex center was in the brain and/or the spinal cord. MethodsAdult male Wistar rats weighing 330-380 g (n = 16) were housed in a climate-controlled environment with food and water ad libitum. All animal experiments ...

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Reflex bradycardia during surgery

Cited by 106 publications

References 40 publications

Gasless Laparoscopic Ovariohysterectomy and Comparison of Serum Levels of Interleukin-6 and C-Reactive Protein after Lohe and Traditional Laparoscopic Ovariohysterectomy in Bitches

Gasless Laparoscopic Ovariohysterectomy and Comparison of Serum Levels of Interleukin-6 and C-Reactive Protein after Lohe and Traditional Laparoscopic Ovariohysterectomy in Bitches

Comparison of Desflurane and Sevoflurane Anaesthesia in Relation to the Risk of Vagally Mediated Reflex Bradycardia during Gastrectomy

Reflex Inhibition of Heart Rate and Efferent Cardiac Sympathetic Outflow Induced by Colorectal Distension in Anesthetized Rats

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