Risk factors for intraoperative bradycardia during ear, nose, throat and maxillofacial surgery

Abstract

Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient's blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068-1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623-0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182-3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232-2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004-1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761-2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB.

Trigeminocardiac reflex: sudden severe bradycardia during open reduction for temporomandibular joint dislocation - A case report -

“…In head and neck surgery, autonomic reflexes such as direct vagal stimulation, TCR or baroreceptor reflex can cause severe bradycardia, even cardiac arrest [4]. The most common cause of intraoperative bradycardia is a drug event [8]. However, in present case, the depth of anesthesia was maintained properly at BIS www.anesth-pain-med.org Cambell et al [11] reported cases of cardiac arrest and bradycardia associated with maxillectomy in 1994.…”

“…The causes of intraoperative bradycardia include drug events, airway and ventilation problems, autonomic reflexes, and epidural anesthesia or spinal anesthesia [8]. In head and neck surgery, autonomic reflexes such as direct vagal stimulation, TCR or baroreceptor reflex can cause severe bradycardia, even cardiac arrest [4].…”

Intraoperative Surgical Complications in Transoral Laser CO2 Microsurgery of the Larynx: An Observational, Prospective, Single-Center Study

“…19 However, there are other factors related to bradycardia such as the use of remifentanil (vagus-related bradycardia), patients older than 50 years, and ear, nose, throat/maxillofacial surgery, with particular attention to ear surgery. 20 However, it is challenging to determine precisely the cause of these episodes during the surgery. In our cohort, those 6 patients affected were older than 50 years.…”

Effect of preemptive treatment of esketamine versus sufentanil on hemodynamics in patients undergoing laryngeal microsurgery: a double-blinded randomized controlled trial

“…[3,4] It was reported that the incidence of bradycardia during otolaryngology surgery is 20.5%. [5] Opioids have been used for analgesia in laryngeal microsurgery. [6-8] However, in view of their pharmacological effects on autonomic function, the use of vagotonic opioids such as fentanyl and its derivatives may lead to bradycardia.…”