Petker Samir, Ahmed Gamal
Anaesthesia, West Herfordshire Hospitals NHS Foundation Trust, London, GBR.
Anaesthesia, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, GBR.
Cureus. 2025 Jul 28;17(7):e88889. doi: 10.7759/cureus.88889. eCollection 2025 Jul.
Vagal-mediated bradycardia is a rare adverse reaction to peritoneal insufflation during laparoscopic procedures. We report an occurrence of vagal-mediated bradycardia during an elective gynaecological procedure, which resulted in an asystolic cardiac arrest. A 55-year-old female patient underwent an elective laparoscopic bilateral salpingo-oophorectomy for multiple symptomatic fibromas. She had no significant past medical history. She had one previous general anaesthetic for a hysteroscopy two years prior. This was carried out under a supraglottic airway device with no documented complications. Systematic clinical examination was also unremarkable, and preoperative routine bloods showed no significant abnormalities. Induction of anaesthesia was uncomplicated and unremarkable. On initiation of peritoneal insufflation, the patient had an instantaneous and significant sinus bradycardia that did not respond to boluses of atropine. She subsequently had an asystolic cardiac arrest. Return of spontaneous circulation occurred on deflation of her peritoneum. The multidisciplinary team (MDT) decision was to terminate the surgery. The patient remained stable post-operatively, and all cardiac investigations were normal. Laparoscopic procedures entail manipulation of pelvic structures and abdominal nerves, notably during peritoneal carbon dioxide insufflation. Severe vagal reactions have been shown to occur, and this can lead, not uncommonly, to an asystolic cardiac arrest. Preventative recommendations currently include limiting peritoneal pressure to 15 mmHg during insufflation, pre-medicating with vagolytic agents, and careful consideration of co-morbid risk factors. Treatment options focus on the intraoperative cardiac arrest protocol outlined by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and supportive care, including immediate termination of further gas insufflation and deflation of the abdomen. Atropine can also be used to treat bradycardia. Anaesthetists should be aware of this life-threatening adverse reaction and understand risk factors, preventative measures and treatment options available during laparoscopic procedures.
迷走神经介导的心动过缓是腹腔镜手术期间腹膜充气的一种罕见不良反应。我们报告了一例择期妇科手术期间发生的迷走神经介导的心动过缓，导致心脏停搏。一名55岁女性患者因多发性有症状的纤维瘤接受了择期腹腔镜双侧输卵管卵巢切除术。她既往无重大病史。两年前她曾因宫腔镜检查接受过一次全身麻醉。此次麻醉是在声门上气道装置下进行的，没有记录到并发症。系统的临床检查也无异常，术前常规血液检查未显示明显异常。麻醉诱导过程顺利且无异常。在开始腹膜充气时，患者立即出现显著的窦性心动过缓，对大剂量阿托品无反应。随后她发生了心脏停搏。在腹膜放气后恢复了自主循环。多学科团队（MDT）决定终止手术。患者术后保持稳定，所有心脏检查均正常。腹腔镜手术需要对盆腔结构和腹部神经进行操作，尤其是在腹膜二氧化碳充气期间。已证明会发生严重的迷走神经反应，这通常会导致心脏停搏。目前的预防建议包括在充气期间将腹膜压力限制在15mmHg，使用抗迷走神经药物进行术前用药，并仔细考虑合并症风险因素。治疗选择集中在英国和爱尔兰麻醉医师协会（AAGBI）概述的术中心脏骤停方案以及支持性护理，包括立即停止进一步的气体充气和腹部放气。阿托品也可用于治疗心动过缓。麻醉医师应意识到这种危及生命的不良反应，并了解腹腔镜手术期间可用的风险因素、预防措施和治疗选择。
