A 35-year-old healthy woman presented for laparoscopic TAHBSO. Induced GA and intubated successfully. Pt hemodynamically stable until umbilical trocar was inserted (no insufflation done yet). Pt went from her baseline sinus bradycardia (50s) to asystole. CPR immediately initiated by surgeon and ACLS protocol followed. ROSC after 1 round of ACLS. After conferring with service, and patient's sister, decision was made to abort procedure and wake the patient up. Emergence completed without difficulty. Pt transported to PACU hemodynamically stable, awake, and moving all extremities.
Cardiac arrest during laparoscopic surgery has been described in the anesthesia literature since the early 1970s and continues to occur today, although at a greatly reduced frequency. Most commonly it occurs as in the case described, as bradycardia progressing rapidly to asystole; the presumed mechanism is excessive vagal stimulation due to irritation of the peritoneum or viscera. Bradycardia typically manifests during initial insufflation but can occur...
