Cardiac arrest during laparoscopic cholecystectomy
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
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