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Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation.
Case Rep Anesthesiol. 2020; 2020:8828914.CR

Abstract

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.

Authors+Show Affiliations

Kuwait Board of Anesthesiology, Kuwait City, Kuwait.Department of Anesthesia and Intensive Care, Jahra Hospital, Al Jahra, Kuwait.Department of Anesthesia and Intensive Care, Jahra Hospital, Al Jahra, Kuwait.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32566315

Citation

Heyba, Mohammed, et al. "Severe Intraoperative Bradycardia During Laparoscopic Cholecystectomy Due to Rapid Peritoneal Insufflation." Case Reports in Anesthesiology, vol. 2020, 2020, p. 8828914.
Heyba M, Khalil A, Elkenany Y. Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation. Case Rep Anesthesiol. 2020;2020:8828914.
Heyba, M., Khalil, A., & Elkenany, Y. (2020). Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation. Case Reports in Anesthesiology, 2020, 8828914. https://doi.org/10.1155/2020/8828914
Heyba M, Khalil A, Elkenany Y. Severe Intraoperative Bradycardia During Laparoscopic Cholecystectomy Due to Rapid Peritoneal Insufflation. Case Rep Anesthesiol. 2020;2020:8828914. PubMed PMID: 32566315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe Intraoperative Bradycardia during Laparoscopic Cholecystectomy due to Rapid Peritoneal Insufflation. AU - Heyba,Mohammed, AU - Khalil,Ahmed, AU - Elkenany,Yasser, Y1 - 2020/06/06/ PY - 2020/04/25/received PY - 2020/05/12/revised PY - 2020/05/19/accepted PY - 2020/6/23/entrez PY - 2020/6/23/pubmed PY - 2020/6/23/medline SP - 8828914 EP - 8828914 JF - Case reports in anesthesiology JO - Case Rep Anesthesiol VL - 2020 N2 - 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. SN - 2090-6382 UR - https://www.unboundmedicine.com/medline/citation/32566315/Severe_Intraoperative_Bradycardia_during_Laparoscopic_Cholecystectomy_due_to_Rapid_Peritoneal_Insufflation L2 - https://doi.org/10.1155/2020/8828914 DB - PRIME DP - Unbound Medicine ER -
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