Intraanaesthetic cardiac arrest – a complication of laparoscopic surgery?

Rely Manolescu¹, Madalina Duţu¹, S. Negoiţă¹, Gabriela Ionescu¹, Mihaela Bucur¹, M. Melnic², D. Corneci¹,
Ş. Marinescu¹

1 Spitalul Universitar de Urgenţă Elias Bucureşti – Clinica de Anestezie şi Terapie Intensivă
2 Spitalul Universitar de Urgenţă Elias Bucureşti – Clinica de Cardiologi

Abstract

The laparoscopic surgery became a frequent alternative to the conventional surgery, but the clinical trials published in the last few years showed a possible association of this type of surgery with some lethal complications. Generally, cardiac arrest has a low incidence in laparoscopic surgery (0.3%).
We present the case of 34 years old male patient without previous cardiac pathology undergoing laparoscopic surgery for acute appendicitis under balanced general anaesthesia. Being haemodynamicaly stable and with a deep enough level of anaesthesia (BIS = 42) the patient developed severe bradicardia (AV = 25/min) 3 minutes after induction of  pneumoperitoneum, followed by asistolia, responsive to i.v. administration of 1 mg atropine and 0.5 mg epinephrine.
Pathogenic pathways of the cardiac arrest are discussed, including the haemodynamic changes induced by pneumoperitoneum. The possibility of an acute coronary syndrome due to the transient left ventricular balloonization induced by catecholamine release (Takotsubo cardiomyopathy) is also taken into consideration. The last supposition is sustained by laboratory arguments: ECG, echocardiography, troponin level and CK-MB/CK ratio.
Takotsubo cardiomyopathy, also known as “transient apical ballooning” of the left ventricle or “broken-heart-syndrome”, is a rare cardiac disease, manifested clinically as an acute coronary syndrome, without any evidence of coronary obstruction. It can lead to unexpected intraanaesthetic haemodynamic deterioration, despite no cardiac risk at the preoperative evaluation.

Keywords: cardiac arrest, laparoscopic surgery, stress-induced cardiomyopathy (Takotsubo), broken-heart-syndrome

J Rom Anest Terap Int 2009; 16: 159-163

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