Bradyarrhythmias and Laparoscopy: A Prospective Study of Heart Rate Changes with Laparoscopy

EDITORIAL COMMENT: We accepted this paper for publication to remind readers that routine procedures performed by the laparoscopist often cause problems for the patient and her anaesthetist. The paper reminds us of the necessary team work between nursing staff, anaesthetist and surgeon which is equally important for other gynaecological operations and for obstetric anaesthesia. Brief operations are often performed for conditions of major significance to the patient; they can be dangerous and should not be referred to as ‘minor’. Summary: : Cardiac arrhythmias are a common complication of laparoscopy. Brady‐arrhythmias (including asystole) may be life‐threatening. The recent introduction of new shorter‐acting muscle relaxants (atracurium and vecuronium), with their lack of vagolytic activity, may exacerbate this situation. At the Royal Women's Hospital there have been several episodes of severe bradyarrhythmias and/or asystole associated with these relaxants. This study evaluated heart rate changes in 49 women during laparoscopy: 47% of patients had arrhythmias, 30% of these being bradyarrhythmias. Nearly all the episodes occurred during carbon dioxide insufflation or with traction on pelvic structures. The life‐threatening nature of this phenomenon should be understood by all anaesthetists and gynaecologists engaged in laparoscopic procedures.