Bradyarrhythmias and laparoscopy: a prospective study of heart rate changes with laparoscopy

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.