Asystolic Cardiac Arrest, Following Insufflation of Pleural Cavity in Robotic Assisted Thoracoscopic Thymectomy (RATT) - Case Report

Abstract

Severe bradycardia has been previously reported during capno mediastinum, but not asystolic cardiac arrest in robotic assisted thoracoscopic surgery with positive pressure insufflation. We describe the case of a 50 year old female undergoing robotic assisted thoracoscopic surgery for thymectomy, which developed asystolic cardiac arrest intraoperatively after initiating one lung ventilation and docking of the robot. Immediate deflation of the thoracic cavity and undocking of robot with administration of atropine and ephedrine helped her heart rate & blood pressure to revive. Greater awareness of this complication particularly in robotic surgeries which usually takes some time to undock will facilitate early diagnosis and encourage preventive measures. We here discuss the possible mechanisms of haemodynamic instability with positive pressure insufflation and propose certain preventive and early corrective measures, specifically when robot is already docked, so as to reduce the related complications.