[Crisis management in abdominal surgery]

During an abdominal surgery, life-threatening events such as severe bradycardia and massive hemorrhage may occur. Reflex bradycardia may arise with surgical manipulation of abdominal contents. Anesthetic agents such as propofol or remifentanil increase the risk of bradycardia. Epidural analgesia using local anesthetics during an abdominal surgery also increases the occurrence of bradycardia and hypotension. Combination of these three factors causes severe bradycardia during the abdominal surgery. Anesthesiologist has to pay close attention to heart rate during the abdominal surgery. The surveillance of Anesthesia-Related Critical Incidents in Japan conducted by Japan Society of Anesthesiologist (JSA) shows that life-threatening events due to hemorrhage during abdominal surgery accounted for 43.9% of all perioperative life-threatening events due to hemorrhage. When we find critical hemorrhage, we have to manage the condition in accordance with "The guideline for critical intraoperative hemorrhage" published by JSA and the Japan Society of Transfusion Medicine and Cell Therapy. The pneumoperitoneum required for laparoscopy induces physiologic changes that complicate anesthetic management and could cause CO2-subcutaneous emphysema, pneumothorax, endobronchial intubation, and gas embolism. During laparoscopy, blood pressure, heart rate, electrocardiogram, end-tidal CO2, and oxygen saturation by pulse oximetry must be continuously monitored.