Laparoscopic surgery has become the mainstay of treatment for uncomplicated appendicitis cases. We describe a case of a 29 year old male with a pertinent past medical history of poorly controlled hypertension who was undergoing a routine laparoscopic appendectomy for confirmed appendicitis and developed bradycardia and subsequent asystolic cardiac arrest approximately one hour into the operation. Urgent cardiopulmonary resuscitation and intravenous (IV) atropine were required to reinitiate sinus cardiac rhythm. While the patient was admitted to the intensive care unit for close monitoring following his operation, he ultimately had an uncomplicated postoperative period and an unremarkable cardiac work up and was consequently discharged the day after his procedure. Numerous causes of cardiovascular collapse during laparoscopic procedures have been discussed in the literature including mechanical obstruction of the vagal nerve, high intraabdominal pressures and gas embolism.
Conflict(s) of Interest
References with DOI
1. Masoomi H, Nguyen NT, Dolich, MO, Mills S, Carmichael JC, Stamos MJ. Laparoscopic appendectomy trends and outcomes in the United States: data from the Nationwide Inpatient Sample (NIS), 2004‐2011.
The American Surgeon. 2014;80:1074-1077.
2. Dai L, Shuai J. Laparoscopic versus open appendectomy in adults and children: A meta-analysis of randomized controlled trials. United European Gastroenterology Journal. 2016;0:1-12. https://doi.org/10.1177/2050640616661931
3. Valentin MD, Tulsyan N, Dolgin, C. Recurrent asystolic cardiac arrest and laparoscopic cholecystectomy: a case report and review of the literature. Journal of the Society of Laparoendoscopic Surgeons. 2004;8:65.
4. Yong J, Hibbert P, Runciman WB, Coventry BJ. Bradycardia as an early warning sign for cardiac arrest during routine laparoscopic surgery. International Journal for Quality in Health Care. 2015;27:473-478. https://doi.org/10.1093/intqhc/mzv077
5. Goshorn K, Abraham R. End tidal carbon dioxide as an early diagnostic tool in carbon dioxide embolus.Am J Respir Crit Care Med. 2017;195:A1984.
6. Henny CP, Hofland J. Laparoscopic surgery: pitfalls due to anesthesia, positioning, and pneumoperitoneum. Surgical Endoscopy and Other Interventional Techniques. 2005;19:1163-1171. https://doi.org/10.1007/s00464-004-2250-z
7. Atkinson T, Giraud G, Togioka B, Jones D, Cigarroa, J. Cardiovascular and ventilatory consequences of laparoscopic surgery. Circulation. 2017;135:700-710. https://doi.org/10.1161/circulationaha.116.023262
Gupta, Rachit; Yousef, George; and Lester, Melissa
"A Rare Case of Asystole During a Laparoscopic Appendectomy In a Young Patient,"
Marshall Journal of Medicine:
1, Article 7.
Available at: https://mds.marshall.edu/mjm/vol4/iss1/7