Abstract
IntroductionAdverse hemodynamic effects with severe bradycardia have been previously reported during positive pressure insufflation of the right thoracic cavity in humans. To the best of our knowledge, this is the first report of asystole during thoracoscopic surgery with positive pressure insufflation.Case presentationA 63-year-old Caucasian woman developed asystole at the onset of positive pressure insufflation of her right hemithorax during a thoracoscopic single-lung ventilation procedure. Immediate deflation of pleural cavity, intravenous glycopyrrolate and atropine administration returned her heart rhythm to normal sinus rhythm. The surgery proceeded in the absence of positive pressure insufflation without any further complications.ConclusionsWe discuss the proposed mechanisms of hemodynamic instability with positive pressure thoracic insufflation, and anesthetic and insufflation techniques that decrease the likelihood of adverse hemodynamic events.
Highlights
Adverse hemodynamic effects with severe bradycardia have been previously reported during positive pressure insufflation of the right thoracic cavity in humans
Hemodynamic consequences of pleural cavity positive pressure insufflation during thoracoscopic procedures have been described in the literature
We present the case of a female patient who underwent right thoracoscopic mediastinal lymph node dissection with one-lung ventilation and developed hypotension and asystole at the commencement of positive pressure insufflation of her right hemithorax
Summary
Hemodynamic consequences of pleural cavity positive pressure insufflation during thoracoscopic procedures have been described in the literature. We present the case of a female patient who underwent right thoracoscopic mediastinal lymph node dissection with one-lung ventilation and developed hypotension and asystole at the commencement of positive pressure insufflation of her right hemithorax. Vitals signs at the time of incision included saturated oxygen 99-100%, noninvasive blood pressure 150/75 mmHg and pulse 80/min Her right hemithorax was insufflated with carbon dioxide to a pressure of 10 mmHg at a rate of 25 L/min. At this point in the procedure we noted changes in our patient’s hemodynamic status. Her blood pressure dropped to 112/63 and her heart rate precipitously dropped to 35/min for a few seconds.
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