Three cases of severe bradycardia occurring during lung cancer operations

Abstract

Careful manipulation is needed to avoid cardiac stress in lung cancer operations. However, we encountered three lung cancer cases that showed unexpected, severe bradycardia or cardiac arrest during surgery. All of these cases were left lung cancer patients, and bradycardia developed suddenly just when the hilum of the left lung was manipulated. Immediate cardiac massage and the injection of positive inotropic cardiac agents resuscitated patients from the bradycardia and cardiac arrest successfully, and then the operations were successfully completed in all cases.
We speculate that the cause of sudden bradycardia is a cardio-vagus reflex induced by stimulation of the pleura where the cardiac neural plexus is distributed. However, this remains uncertain. Nowadays, thoracoscopic surgery is available in respiratory surgery; however, there is anxiety over whether immediate direct cardiac massage is possible or not because the incision is too small to insert one's hand, consequently resulting in serious trouble.
We expect that our experience will help clarify the mechanism of sudden bradycardia, as well as prevent and treat it.