Cardiac Arrhythmias during
Laparoscopy
Arrhythmias during laparoscopy may have several causes (see Chapter
34
). The responsibility of the increased PaCO2
for the arrhythmias occurring during laparoscopy was questioned. Arrhythmias are
not correlated with PaCO2
and may develop
early during insufflation, when high PaCO2
is unlikely.
Reflex increases of vagal tone may result from sudden stretching
of the peritoneum and electrocoagulation of the fallopian tubes.[60]
Bradycardia, cardiac arrhythmias, and asystole can develop. Vagal stimulation is
accentuated if the level of anesthesia is too superficial or if the patient is taking
β-blocking drugs. These events are easily and quickly reversible. Treatment
consists of interruption of insufflation, atropine administration, and deepening
of anesthesia after recovery of heart rate.
Cardiac irregularities most often occur early during insufflation,
when pathophysiologic hemodynamic changes are the most intense. For this reason,
arrhythmias may also reflect intolerance of these hemodynamic disturbances in patients
with known or latent cardiac disease. Gas embolism can also result in cardiac arrhythmias.
