title: Bradycardia as an early warning sign for cardiac arrest during routine laparoscopic surgery.
abstract: OBJECTIVE
  The aim of this study was to identify clinical patterns of occurrence, management and outcomes surrounding cardiac arrest during laparoscopic surgery using the Australian Incident Monitoring Study (AIMS) database to guide possible prevention and treatment.
  
  
  METHODS
  The AIMS database includes incident reports from participating clinicians from secondary and tertiary healthcare centres across Australia and New Zealand.
  
  
  METHODS
  The AIMS database holds over 11 000 peri- and intraoperative incidents.
  
  
  METHODS
  The primary outcome was to characterize the pattern of events surrounding cardiac arrest. The secondary outcome was to identify successful management strategies in the possible prevention and treatment of cardiac arrest during laparoscopic surgery.
  
  
  RESULTS
  Fourteen cases of cardiac arrest during laparoscopic surgery were identified. The majority of cases occurred in 'fit and healthy' patients during elective gynaecological and general surgical procedures. Twelve cases of cardiac arrest were directly associated with pneumoperitoneum with bradycardia preceding cardiac arrest in 75% of these. Management included deflation of pneumoperitoneum, atropine administration and cardiopulmonary resuscitation with circulatory restoration in all cases. The results imply vagal mechanisms associated with peritoneal distension as the predominant contributor to bradycardia and subsequent cardiac arrest during laparoscopy.
  
  
  CONCLUSIONS
  Bradycardia during gas insufflation is not necessarily a benign event and appears to be a critical early warning sign for possible impending and unexpected cardiac arrest. Immediate deflation of pneumoperitoneum and atropine administration are effective measures that may alleviate bradycardia and possibly avert progression to cardiac arrest.
authors.affiliation: Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yong
authors.affiliation: The Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Hibbert
authors.affiliation: School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia.
authors.forename: William B
authors.initials: WB
authors.lastname: Runciman
authors.affiliation: Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Brendon J
authors.initials: BJ
authors.lastname: Coventry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D001919:Bradycardia / Q000503:physiopathology*; D016887:Cardiopulmonary Resuscitation; D016208:Databases, Factual; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011237:Predictive Value of Tests; D055815:Young Adult
keywords: bradycardia; cardiac arrest; cardiopulmonary resuscitation; laparoscopy; pneumoperitoneum