Asystole following positive pressure insufflation of right pleural cavity: a case report

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.

Asystolic Cardiac Arrest, Following Insufflation of Pleural Cavity in Robotic Assisted Thoracoscopic Thymectomy (RATT) - Case Report

“…These changes are more marked in right sided carbomediastinum than the left side as it is a low pressure chamber in the cardiovascular system [3][4][5][6][7][8][9][10][11][12][13]. In review literature, the American association of Gynecology reported an incidence of one in 2500 cases asystolic arrest during laparoscopy [7].…”

“…One more case of asystole during laparoscopic Cholecystectomy has been described [8]. One case of asystole following positive pressure insufflation of right pleural cavity during hilar lymphadenectomy is also described [5]. But till date asystole during the robotic assisted thoracic surgery has not been reported.…”

Robot‐Assisted Thoracic Surgery (RATS): Perioperative Nursing Professional Development Program

“…Use of CO 2 insufflation in RATS improves the field of vision by moving anatomical structures away from the field of view and reduces the incidence of camera fogging. Patient risks from CO 2 insufflation include hemodynamic changes such as decreased preload, hypotension, 1 increased central venous pressure, and increased pulmonary arterial pressure 15 ; and precipitation of hypercarbia and acidosis 16 …”

“…hemodynamic changes such as decreased preload, hypotension, 1 increased central venous pressure, and increased pulmonary arterial pressure 15 ; and…”

Cardiorespiratory Impact of Intrathoracic Pressure Overshoot During Artificial Carbon Dioxide Pneumothorax: a Randomized Controlled Study

“…However, insu ation of CO 2 creates physiologic effects similar to a tension pneumothorax. Acute changes of intrathoracic pressure during the initial insu ation of CO 2 can compromise cardiopulmonary function and patient safety [5][6][7]. Currently, few reports have observed the characteristics of intrathoracic pressure after arti cial CO 2 pneumothorax has been established and its potential impacts on cardiorespiratory function.…”