Department of Anesthesiology, Wolfson Medical Center, Holon, Israel.
Division of Anesthesiology and Intensive Care and Pain Medicine, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
World J Surg. 2019 Jun;43(6):1490-1496. doi: 10.1007/s00268-019-04935-x.
A recent analysis found bradycardia during laparoscopy as a potential early warning sign of cardiac arrest. Knowledge regarding bradycardia frequency and its consequences during laparoscopy is limited.
Using the computerized record database, files of 9915 patients undergoing laparoscopic surgery, between June 2008 and August 2013 at a tertiary, academic medical center, were screened for intraoperative bradycardia (heart rate <50 beats/min for at least three consecutive measures).
Intraoperative bradycardia occurred in 1540 (15.5%) patients, in the majority (945, 61.3%) heart rate decreased to <45 beats/min. Mean (SD) duration of bradycardia was 14.8 (16.8) min. Bradycardia was more prevalent in males, older patients, smokers, patients with comorbidities and those treated with β, α and calcium channel blockers. The majority of events were related to CO insufflation and bolus opioid administration. In 1343 (87%), noteworthy decreases in blood pressure were recorded; the average (SD) drop in systolic blood pressure was 35 (21) mmHg. Pharmacological intervention to alleviate bradycardia was used in up to 23% of episodes. Bradycardia did not result in intraoperative cardiac arrest, neither did it increase the frequency of intensive care unit admission or mortality rate.
Bradycardia is common during laparoscopy. Despite being more prevalent in older and sicker patients, bradycardia did not significantly affect outcome, suggesting that routine preventive measures do not need to be implemented. Rather, intraoperative bradycardia events should be wisely followed with prompt response, when hemodynamic perturbations occur, the threshold of which is yet to be defined.
最近的一项分析发现，腹腔镜检查中的心动过缓是心脏骤停的潜在早期预警信号。关于腹腔镜检查中心动过缓的频率及其后果的知识有限。
使用计算机记录数据库，筛选了 2008 年 6 月至 2013 年 8 月期间在一家三级学术医疗中心接受腹腔镜手术的 9915 名患者的档案，以寻找术中心动过缓（至少连续三次测量心率<50 次/分钟）。
1540 名（15.5%）患者发生术中心动过缓，其中大多数（945 名，61.3%）患者的心率降至<45 次/分钟。心动过缓的平均（SD）持续时间为 14.8（16.8）分钟。心动过缓在男性、老年患者、吸烟者、合并症患者和接受β、α和钙通道阻滞剂治疗的患者中更为常见。大多数事件与 CO 充气和阿片类药物推注有关。在 1343 例（87%）中记录到显著的血压下降；收缩压的平均（SD）下降为 35（21）mmHg。高达 23%的心动过缓发作使用了药物干预来缓解。心动过缓并未导致术中心脏骤停，也未增加重症监护病房入住率或死亡率。
腹腔镜检查中心动过缓很常见。尽管在老年和病患者中更为常见，但心动过缓并未显著影响结局，表明无需实施常规预防措施。相反，应明智地监测术中心动过缓事件，并在出现血流动力学紊乱时迅速作出反应，但其阈值尚未确定。
