Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, Hebei Province, China.
Medicine (Baltimore). 2023 Aug 25;102(34):e34775. doi: 10.1097/MD.0000000000034775.
Despite various advantages of laparoscopic surgical procedures, artificial pneumoperitoneum might lead to hemodynamic fluctuations including severe bradycardia and cardiac arrest. Atropine is usually proposed to treat intraoperative severe bradycardia ( < 40 beats per minute). However, atropine could induce ventricular arrhythmias, which might be life-threatening in severe case.
Here, we reported a 41-year-old female who was diagnosed with gallbladder polyps and was scheduled for laparoscopic cholecystectomy under general anesthesia.
Bradycardia occurred suddenly during the operation and atropine was injected intravenously. Eventually the patient developed ventricular tachycardia and acute heart failure.
We organized an urgent consultation and the patient was treated immediately.
Fortunately, the patient experienced no complications after timely diagnosis and treatment. After 6 months of follow-up, her New York Heart Association classification was I with no complications.
This case highlighted that the administration of atropine to treat bradycardia may lead to ventricular tachycardia and acute heart failure, and anesthesiologists should remain vigilant to avoid potentially life-threatening consequences.
尽管腹腔镜手术具有诸多优势，但人工气腹可能导致包括严重心动过缓和心跳骤停在内的血流动力学波动。通常建议使用阿托品治疗术中严重心动过缓（<40 次/分钟）。然而，阿托品可诱发室性心律失常，在严重情况下可能危及生命。
我们报告了一例 41 岁女性，诊断为胆囊息肉，拟在全身麻醉下接受腹腔镜胆囊切除术。
术中突发心动过缓，给予静脉注射阿托品。最终患者出现室性心动过速和急性心力衰竭。
我们立即组织了紧急会诊并对患者进行了治疗。
所幸，患者经及时诊断和治疗后未出现并发症。随访 6 个月后，纽约心脏病协会心功能分级为 I 级，无并发症。
该病例强调，阿托品治疗心动过缓可能导致室性心动过速和急性心力衰竭，麻醉医生应保持警惕，避免潜在的危及生命的后果。
