Bradycardia During Laparoscopic Surgeries: A Retrospective Cohort Study
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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 CO2 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.
Anesthesia Information Management System
American Society of Anesthesiologists physical status classification system
Intensive care unit
Compliance with ethical standards
Ethical approval for this study (Ethical Committee No. 0173-13-TLV) was provided by the Ethical Committee of the Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Chairperson Prof. Marcel Topilsky) on May 23, 2013.
Informed consent was waived by the ethical committee.
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