Cardiac arrest during laparoscopic cholecystectomy

  • Carlos Eduardo Laverde Sabogal Anesthesiology Service, Hospital Universitario Mayor y Barrios Unidos-Méderi, Bogotá, Colombia, Universidad del Rosario, Bogotá, Colombia
  • David Betancur Vivas Universidad del Rosario, Bogotá, Colombia
Keywords: Heart Block, Atrioventricular Block, Cholecystectomy laparoscopic, Heart arrest, Anesthesia epidural

Abstract

Objective: To undertake a literature review on third-degree complete atrioventricular block inlaparoscopic cholecystectomy, describing its incidence, etiology and management update.

Materials and methods: This is a case discussion of a patient with cardiac arrest followingcomplete wide-complex heart block during a laparoscopic cholecystectomy, its manage-ment, and outcomes. The literature search included PubMed, Scielo and Bireme.

Results: Complete or third degree paroxysmal AV block is a rare occurrence that may be trig-gered by surgical vagal stimuli (surgical stress, pneumoperitoneum) and by non-surgicalstimuli (carotid massage, coughing, exercise, vomiting and swallowing), in addition tostimuli from myocardial ischemia and cardiac conduction anomalies. This is the first casein our institution but there are very few cases described in the world literature and none atthe national level.

Conclusions: Enhanced knowledge and experience of the anesthesiologist is required for thediagnosis and management of complete heart block in laparoscopic cholecystectomy, whichis the most frequent laparoscopic surgical procedure worldwide. The use of epidural anes-thesia associated with general anesthesia for upper abdominal and chest surgery reducesby five fold the occurrence of postoperative cardiac arrhythmia. Three safety measures arerecommended for ASA 3 and 4 patients with cardiovascular comorbidity: consider invasiveblood pressure monitoring, head at 10◦and limit the pneumoperitoneal pressure to 7 mmHg.

References

1. Bocanegra J, Caicedo J. Arritmias intraoperatorias: nodo sinusal enfermo manifestado durante anestesia general. Rev Colomb Anestesiol. 2011;39:259-65.
2. Sachs A, Traynor RL. Paroxysmal complete auriculo-ventricular heart-block. A case report. Am Heart J. 1933;9:267-71.
3. O'Reilly MV, Krauthammer MJ. Cope's sign and reflex bradycardia in two patients with cholecystitis. BMJ.1971;2:146.
4. Franzen D. Complet atriventricular block in a patient with acute cholecystitis: A case of cardiobiliary reflex? Eur J Emerg Med. 2009;16:346.
5. Loureiro ER, Klein SC, Pavan CC, Almeida LDLF, Silva FHP, Paulo DNS. Laparoscopic cholecystectomy in 960 elderly patients. Rev Bras Anestesiol [periódico en Internet]. 2011;38. Disponible en URL:http://www.scielo.br/rcbc
6. Biswas TK, Pembroke A. Asystolic cardiac arrest during laparoscopic cholecystectomy. Anaesth Intensive Care. 1994;22:289-91.
7. Gautam B, Shrestha BR. Cardiac arrest during laparoscopic cholecystectomy under general anaesthesia: A study into four cases. Kathmandu Univ Med J (KUMJ). 2009;7:280-8.
8. El-Sherif N, Scherlag BT, Lazzara R. Experimental model study of Mobitz type II and paroxismal atrioventricular block. Am J Cardiol. 1974;34:309-17.
9. El-Sherif N, Scherlag BT, Lazzara R. An appraisal of second degree and paroxysmal atrioventricular block. Eur J Cardiol. 1976;4:117-30.
10. Cunningham AJ, Brull SJ. Laparoscopic cholecystectomy: Anesthetic implications. Anesth Analg. 1993;76:1120-33.
11. Carmichael BE. Laparoscopy: Cardiac consideration. Fertil Steril. 1971;22:69-70.
12. Valentin M, Tulsyan N. Recurrent aystolic cardiac arrest and laparoscopic cholecystectomy: A case report and review of the literature. JSLS. 2004;8:65-8.
13. Mehta D, Saverymuttu SH, Camm AJ. Recurrent paroxysmal complete heart block induced by vomiting. Chest. 1988;94:433-5.
14. Lee D, Beldner S, Pollaro F, Jadonath R, Maccaro P, Goldner B. Cough-induced heart block. PACE. 1999;22:1270-1.
15. Bortolotti M, Cirignotta F, Labo G. Atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm. JAMA. 1982;248:2297-9.
16. Shohat-Zabarski R, Iakobishvili Z, Kusniec J, Mazur A, Strasberg B. Paroxysmal atrioventricular block: Clinical experience with 20 patients. Int J Cardiol. 2004;97:399-405.
17. Block M. Heart block in patients after bariatric surgery accompanying sleep apnea. Obesity Surg. 2001;11:627-30.
18. Sprung J. Recurrent complete heart block in a healthy patient during laparoscopic electrocauterization of the fallopian tube. Anesthesiology. 1998;88:1401-3.
19. Wahba RW, Béique F, Kleiman SJ. Cardiopulmonary function and laparoscopic cholecystectomy. Can J Anaesth. 1995;42:51-63.
20. Joris LT, Noirot DP, Legrand MJ, Jacquet NJ, Lamy LM. Hemodimanic changes during laparoscopic cholecystectomy. Anesth Analg. 1993;76:1067-71.
21. Joris LT, Lamy LM. Neurocrine changes during pneumoperitoneum for laparoscopic cholecystectomy. Br J Anaesth. 1993;70:A33.
22. Aono H. Stress responses in three different anesthesic techniques for carbon dioxide laparoscopic cholecystectomy.J Clin Anesthesia. 1998;10:546-50.
23. Gonima E, Martinez J, Perilla C. Anestesia general vs anestesia peridural en colecistectomía laparoscópica. Rev Colomb Anestesiol. 2013;35:203-13.
24. Oliveira RM, Tenório SB, Tanaka PP, Precoma D. Control del dolor por bloqueo epidural y aparición de arritmias cardíacas en el postoperatorio de procedimientos quirúrgicos torácicos y abdominales altos: estudio comparativo. Rev Bras Anestesiol. 2012;62:10-8.
25. Field J, Hazinski M, Sayre M. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation. 2010;122 Suppl 2:S640-56.
26. Lorentz MN, Vianna BSB. Arritmias cardiacas y anestesia. Rev Bras Anestesiol. 2011;61:805-13.
How to Cite
1.
Laverde Sabogal CE, Betancur Vivas D. Cardiac arrest during laparoscopic cholecystectomy. Colomb. J. Anesthesiol. [Internet]. 2013Oct.1 [cited 2022Jul.6];41(4):298 -301. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/673

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Published
2013-10-01
How to Cite
1.
Laverde Sabogal CE, Betancur Vivas D. Cardiac arrest during laparoscopic cholecystectomy. Colomb. J. Anesthesiol. [Internet]. 2013Oct.1 [cited 2022Jul.6];41(4):298 -301. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/673
Section
Case Report / Case Series

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