Temporary pacemaker insertion for severe bradycardia following pneumoperitoneum during robot-assisted radical prostatect
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CASE REPORT
Temporary pacemaker insertion for severe bradycardia following pneumoperitoneum during robot‑assisted radical prostatectomy: a case report Fumito Yamabe* , Yozo Mitsui, Orie Hoshino, Tomo Shimizu, Mizuki Kasahara, Hideyuki Kobayashi and Koichi Nakajima
Abstract Background: Pneumoperitoneum to maintain a constant gas flow to assist various surgeries is known to cause severe bradycardia and has been linked to heart failure;; however, a recent study demonstrated that it is not linked to poorer surgical outcomes; accordingly, it does not require routine preventive measures. Thus, whether there is a link between sudden bradycardia development and surgical procedures is controversial. We report the case of severe bradycardia that occurred along with a complete atrioventricular block (CAVB) during peritoneum creation in robotassisted radical prostatectomy (RARP). Case presentation: A 72-year-old man presented at our hospital with prostate cancer and underwent RARP. After pneumoperitoneum, severe bradycardia and CAVB were observed; thus, the surgery was extended by inserting a temporary pacemaker (TPM). Conclusion: Because of the difficulty in performing emergency procedures in robot-assisted surgeries, the current case is reported to provide an awareness that surgeons should be cautious of the possible complication of bradycardia and CAVB during such operations, and thus should take steps necessary for managing induction of such conditions. Keywords: Robot-assisted radical prostatectomy (RARP), Bradycardia, Pneumoperitoneum, Temporary pacemaker Background A report has indicated the existence of bradycardia during operation in various surgical fields because of vagal reflex caused by surgical stimulation or drugs [1]. Bradycardia during pneumoperitoneum manipulations is considered a sign for predicting unexpected cardiac arrest [2], and thus requires urgent measures and treatment. In fact, the incidence of cardiac arrest during laparoscopic surgery ranges from 0.002 to 0.02% [3]. However, a recent
report indicated no possibility of bradycardia and subsequent risk of cardiac arrest associated with poorer surgical outcomes, and hence ruling out the requirement for routine prevention [4]. In this study, we treated a patient who exhibited severe bradycardia with a complete atrioventricular block (CAVB) during robot-assisted radical prostatectomy (RARP). The surgery was extended by insertion of a temporary pacemaker (TPM), which we report along with a review of related cases in the literature.
*Correspondence: [email protected] Department of Urology, Faculty of Medicine, Toho University, Tokyo 143‑8540, Japan © The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. T
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