Monitor alarm during a laparoscopic operation
The case
66-year-old woman. Monitor alarm during a laparoscopic operation
Dual-chamber pacemaker implanted four years ago for complete heart block after aortic valve replacement, pacing-dependent at her last device check. Bisoprolol and apixaban, the apixaban held for surgery.
On arrival
- HR
- 42
- SpO₂ (%)
- 96
- Respiratory rate
- 12
- Temperature (°C)
- 36.1
- Systolic BP (mmHg)
- 78
- Diastolic BP (mmHg)
- 46
Stage 1 of 2
Eleni Vasilakis is forty minutes into a laparoscopic cholecystectomy under general anaesthesia. As the surgeon works on the gallbladder bed with monopolar diathermy, the monitor alarms and the pulse oximeter trace flattens for a few seconds at a time before recovering. She is ventilated, the end-tidal carbon dioxide dips with each episode, and the surgeon has not noticed. This is the rhythm strip recorded across one of them.
Stage 2 of 2
The diathermy is stopped and a magnet is taped over the generator. The oximetry trace steadies and the end-tidal carbon dioxide returns to its previous level. The surgeon resumes with short bursts while the strip runs.
Observations
- HR
- 85
- SpO₂ (%)
- 99
- Respiratory rate
- 12
- Temperature (°C)
- 36.1
- Systolic BP (mmHg)
- 106
- Diastolic BP (mmHg)
- 62
Diagnosis
Pacemaker oversensing of diathermy causing ventricular asystole
This tracing was generated, not recorded. It opens in the studio with every dial live.
Discussion
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