Anaes Cases · Perioperative cardiac arrest
Bradycardia and asystole during laparoscopy
Hot case on intraoperative bradycardia progressing to asystole: ERC 2025 bradycardia drugs, the non-shockable arrest pathway, the laparoscopy modification and the NAP7 outcomes for bradycardic arrest.
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Prompt
During laparoscopy the heart rate slows abruptly, then the monitor shows asystole. Manage.
Scenario
During a laparoscopic cholecystectomy the heart rate falls abruptly, the arterial trace flattens and the monitor shows asystole. Manage.
References3ShowHide
- [1]Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2025 Adult Advanced Life Support Resuscitation 215 (2025) 110769, 2025.Source
- [2]Lott C, Karageorgos V, Abelairas-Gomez C, et al. European Resuscitation Council Guidelines 2025 Special Circumstances in Resuscitation Resuscitation 215 (2025) 110753, 2025.Source
- [3]Armstrong RA, Cook TM, Kane AD, et al. Peri-operative cardiac arrest: management and outcomes of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia, 2024.PMID 37972480