Cardiac arrest during laparoscopic cholecystectomy

Objective: To undertake a literature review on third-degree complete atrioventricular block in laparoscopic cholecystectomy, describing its incidence, etiology and management update. Materials and methods: This is a case discussion of a patient with cardiac arrest following complete wide-complex heart block during a laparoscopic cholecystectomy, its management, and outcomes. The literature search included PubMed, Scielo and Bireme. Results: Complete or third degree paroxysmal AV block is a rare occurrence that may be triggered by surgical vagal stimuli (surgical stress, pneumoperitoneum) and by non-surgical stimuli (carotid massage, coughing, exercise, vomiting and swallowing), in addition to stimuli from myocardial ischemia and cardiac conduction anomalies. This is the first case in our institution but there are very few cases described in the world literature and none at the national level. Conclusions: Enhanced knowledge and experience of the anesthesiologist is required for the diagnosis and management of complete heart block in laparoscopic cholecystectomy, which is the most frequent laparoscopic surgical procedure worldwide. The use of epidural anesthesia associated with general anesthesia for upper abdominal and chest surgery reduces by five fold the occurrence of postoperative cardiac arrhythmia. Three safety measures are recommended for ASA 3 and 4 patients with cardiovascular comorbidity: consider invasive blood pressure monitoring, head at 10? and limit the pneumoperitoneal pressure to 7 mmHg.