Asystolic cardiac arrest during balloon insufflation for endoscopic extraperitoneal radical prostatectomy

Hemodynamic changes during abdominal laparoscopic procedures have been described as multifactorial phenomena. We report the possible occurrence of bradycardia and asystolic cardiac arrest during insufflation of the balloon trocar as a rare and serious but reversible complication during endoscopic extraperitoneal radical prostatectomy (EERP) for management of localized prostate cancer.

Between 2003 and 2006, 430 patients underwent EERP for localized prostate cancer. The anesthetic protocol was standardized. The EERP was started with creating a preperitoneal space by insufflation of air through a balloon trocar inserted tangentially to the cutaneous plane toward the pubis.

Review of the intraoperative data of our patient population revealed the occurrence of bradycardia and/or asystolic cardiac arrest during insufflation of the balloon trocar in three patients. The overall incidence of this complication in our population was therefore 0.7 per 100 patients. Further, during the insufflation of the balloon, a maximum pressure of 120 mm Hg has been measured.

Severe vagal reaction triggered by manipulation of pelvic structures or nerves by the insufflated balloon trocar resulted in asystolic cardiac arrest in three patients. The life-threatening nature of this phenomenon should be understood by all anesthesiologists and urologists engaged in laparoscopic procedures.