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Open Access Case report

Asystole following positive pressure insufflation of right pleural cavity: a case report

Kari M Forde-Thielen and Mojca R Konia*

Author Affiliations

Department of Anesthesiology, University of Minnesota, Box 294, B515 Mayo Memorial Building, 420 Delaware Street, SE, Minneapolis, MN 55455, USA

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Journal of Medical Case Reports 2011, 5:257  doi:10.1186/1752-1947-5-257

Published: 30 June 2011

Abstract

Introduction

Adverse hemodynamic effects with severe bradycardia have been previously reported during positive pressure insufflation of the right thoracic cavity in humans. To the best of our knowledge, this is the first report of asystole during thoracoscopic surgery with positive pressure insufflation.

Case presentation

A 63-year-old Caucasian woman developed asystole at the onset of positive pressure insufflation of her right hemithorax during a thoracoscopic single-lung ventilation procedure. Immediate deflation of pleural cavity, intravenous glycopyrrolate and atropine administration returned her heart rhythm to normal sinus rhythm. The surgery proceeded in the absence of positive pressure insufflation without any further complications.

Conclusions

We discuss the proposed mechanisms of hemodynamic instability with positive pressure thoracic insufflation, and anesthetic and insufflation techniques that decrease the likelihood of adverse hemodynamic events.