A case of bradycardia and asystole during thoracoscopic surgery for left lung cancer

Abstract

A 69-year-old woman underwent thoracoscopic left upper lobectomy with nodal dissection for lung adenocarcinoma. When we were dissecting the left main pulmonary artery at the hilum, severe bradycardia suddenly developed, leading asystole. We immediately tapped the heart with a small gauze ball and an index finger through the ports. A spontaneous heart beat resumed one minute after the onset of asystole. We considered the cause of this cardiac event as a vagal reflex and resumed the operation after administering intravenous atropine. A second severe bradycardia emerged on subaortic nodal dissection. The heart rate recovered soon after suspending the nodal dissection. Subsequently, we completed the planned procedure while being cautious about bradycardia. Intraoperative cardiac arrest induced by a vagal reflex during lung surgery has been rarely reported, and all reported cases including the present case were limited to left-side operations. The cardiac plexus is more developed in the left pulmonary hilum, and manipulation around this area involves the potential risk of a serious vagal reflex, which can result in cardiac arrest. Therefore, we should consider intraoperative bradycardia as an adverse sign, and prompt response to bradycardia is required to prevent the occurrence of cardiac arrest.