title: Cardiac arrest after intragastric balloon insertion in a super-obese patient.
abstract: A super-obese patient who suffered from severe sleep apnea (SSA) and other comorbidities underwent insertion of a BioEnterics intragastric balloon (BIB) before bariatric surgery. During the night, he was victim of cardiac arrest. After cardiopulmonary resuscitation and return of spontaneous circulation, he was transferred to intensive care unit. Two hours later, he developed an unexpected symptomatic bradycardia, and BIB was removed. The patient had no further cardiac complications, but he had a poor neurological outcome. In our opinion, such a severe cardiac event was the result of several causes. The BIB induces vagal nerve activation by stretching the gastric wall. In addition, super-obese patients with sleep apnea and other comorbitities have an increased risk of potentially fatal cardiac arrhythmias especially during the night. For all these reasons, we think that these patients may benefit from further preoperative cardiac investigations and a more intensive control during the first postinsertion day.
authors.affiliation: Department of Anesthesia and Intensive Care, AUOS-University of Siena, Via.le Bracci, 16, 53100, Siena, Italy. lucia.cuba@virgilio.it.
authors.forename: Lucia
authors.initials: L
authors.lastname: Cubattoli
authors.affiliation: Department of Anesthesia and Intensive Care, AUOS-University of Siena, Via.le Bracci, 16, 53100, Siena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Barneschi
authors.affiliation: Department of Anesthesia and Intensive Care, AUOS-University of Siena, Via.le Bracci, 16, 53100, Siena, Italy.
authors.forename: Egidio
authors.initials: E
authors.lastname: Mastrocinque
authors.affiliation: Department of Anesthesia and Intensive Care, AUOS-University of Siena, Via.le Bracci, 16, 53100, Siena, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Bonucci
authors.affiliation: Department of Anesthesia and Intensive Care, AUOS-University of Siena, Via.le Bracci, 16, 53100, Siena, Italy.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Giomarelli
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D001919:Bradycardia / Q000209:etiology; D016887:Cardiopulmonary Resuscitation; D016145:Endoscopy, Digestive System; D015905:Gastric Balloon / Q000009:adverse effects*; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D018458:Persistent Vegetative State / Q000175:diagnosis / Q000209:etiology; D020181:Sleep Apnea, Obstructive / Q000150:complications