title: Asystolic cardiac arrest during balloon insufflation for endoscopic extraperitoneal radical prostatectomy.
abstract: OBJECTIVE
  Hemodynamic changes during abdominal laparoscopic procedures have been described as multifactorial phenomena. We report the possible occurrence of bradycardia and asystolic cardiac arrest during insufflation of the balloon trocar as a rare and serious but reversible complication during endoscopic extraperitoneal radical prostatectomy (EERP) for management of localized prostate cancer.
  
  
  METHODS
  Between 2003 and 2006, 430 patients underwent EERP for localized prostate cancer. The anesthetic protocol was standardized. The EERP was started with creating a preperitoneal space by insufflation of air through a balloon trocar inserted tangentially to the cutaneous plane toward the pubis.
  
  
  RESULTS
  Review of the intraoperative data of our patient population revealed the occurrence of bradycardia and/or asystolic cardiac arrest during insufflation of the balloon trocar in three patients. The overall incidence of this complication in our population was therefore 0.7 per 100 patients. Further, during the insufflation of the balloon, a maximum pressure of 120 mm Hg has been measured.
  
  
  CONCLUSIONS
  Severe vagal reaction triggered by manipulation of pelvic structures or nerves by the insufflated balloon trocar resulted in asystolic cardiac arrest in three patients. The life-threatening nature of this phenomenon should be understood by all anesthesiologists and urologists engaged in laparoscopic procedures.
authors.affiliation: Department of Urology, Helios Clinics Berlin-Buch, University Medical School of Charité, Berlin, Germany. rhoda@ucsd.edu
authors.forename: M Raschid
authors.initials: MR
authors.lastname: Hoda
authors.forename: Michael
authors.initials: M
authors.lastname: Friedrichs
authors.forename: Christoph
authors.initials: C
authors.lastname: Kümmel
authors.forename: Thomas
authors.initials: T
authors.lastname: Nitzke
authors.forename: Gralf
authors.initials: G
authors.lastname: Popken
mesh_terms: D002404:Catheterization / Q000009:adverse effects*; D004724:Endoscopy / Q000009:adverse effects*; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D007327:Insufflation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects*