Bradycardia During Laparoscopic Surgeries: A Retrospective Cohort Study

  • Inbal Dabush-Elisha
  • Or Goren
  • Aviram Herscovici
  • Idit MatotEmail author
Original Scientific Report



A recent analysis found bradycardia during laparoscopy as a potential early warning sign of cardiac arrest. Knowledge regarding bradycardia frequency and its consequences during laparoscopy is limited.


Using the computerized record database, files of 9915 patients undergoing laparoscopic surgery, between June 2008 and August 2013 at a tertiary, academic medical center, were screened for intraoperative bradycardia (heart rate <50 beats/min for at least three consecutive measures).


Intraoperative bradycardia occurred in 1540 (15.5%) patients, in the majority (945, 61.3%) heart rate decreased to <45 beats/min. Mean (SD) duration of bradycardia was 14.8 (16.8) min. Bradycardia was more prevalent in males, older patients, smokers, patients with comorbidities and those treated with β, α and calcium channel blockers. The majority of events were related to CO2 insufflation and bolus opioid administration. In 1343 (87%), noteworthy decreases in blood pressure were recorded; the average (SD) drop in systolic blood pressure was 35 (21) mmHg. Pharmacological intervention to alleviate bradycardia was used in up to 23% of episodes. Bradycardia did not result in intraoperative cardiac arrest, neither did it increase the frequency of intensive care unit admission or mortality rate.


Bradycardia is common during laparoscopy. Despite being more prevalent in older and sicker patients, bradycardia did not significantly affect outcome, suggesting that routine preventive measures do not need to be implemented. Rather, intraoperative bradycardia events should be wisely followed with prompt response, when hemodynamic perturbations occur, the threshold of which is yet to be defined.



Anesthesia Information Management System


American Society of Anesthesiologists physical status classification system


Blood pressure


Intensive care unit


Compliance with ethical standards

Ethical approval

Ethical approval for this study (Ethical Committee No. 0173-13-TLV) was provided by the Ethical Committee of the Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Chairperson Prof. Marcel Topilsky) on May 23, 2013.

Informed consent

Informed consent was waived by the ethical committee.


  1. 1.
    Yong J, Hibbert P, Runciman WB et al (2015) Bradycardia as an early warning sign for cardiac arrest during routine laparoscopic surgery. Int J Qual Health Care 27:473–478CrossRefGoogle Scholar
  2. 2.
    Aghamohammadi H, Mehrabi S, Mohammad Ali Beigi F (2009) Prevention of bradycardia by atropine sulfate during urological laparoscopic surgery: a randomized controlled trial. Urol J 6:92–95Google Scholar
  3. 3.
    Ambrose C, Buggy D, Farragher R et al (1998) Pre-emptive glycopyrrolate 0.2 mg and bradycardia during gynaecological laparoscopy with mivacurium. Eur J Anaesthesiol 15:710–713CrossRefGoogle Scholar
  4. 4.
    Bogani G, Uccella S, Cromi A et al (2014) Low vs standard pneumoperitoneum pressure during laparoscopic hysterectomy: prospective randomized trial. J Minim Invasive Gynecol 21:466–471CrossRefGoogle Scholar
  5. 5.
    Briassoulis G, Spanaki AM, Vassilaki E et al (2007) Potentially life-threatening bradycardia after remifentanil infusion in a child. Acta Anaesthesiol Scand 51:1130CrossRefGoogle Scholar
  6. 6.
    Hameedullah H, Khan FA (1997) Incidence of intra-operative bradycardia. Comparison of atracurium and vecuronium in gynaecological surgery. Anesthesia 52:1221–1224CrossRefGoogle Scholar
  7. 7.
    Harvey A, Anderson L, Broome IJ (1999) A comparison of the effect of rocuronium and vecuronium on heart rate during gynaecological laparoscopy. Anesthesia 54:1212–1216CrossRefGoogle Scholar
  8. 8.
    Kim DK, Ahn HJ, Lee SW et al (2015) Analysis of factors related to vagally mediated reflex bradycardia during gastrectomy. J Anesth 29:874–880CrossRefGoogle Scholar
  9. 9.
    Myles PS (1991) Bradyarrhythmias and laparoscopy: a prospective study of heart rate changes with laparoscopy. Aust N Z J Obstet Gynaecol 31:171–173CrossRefGoogle Scholar
  10. 10.
    Reed DN Jr, Duff JL (2000) Persistent occurrence of bradycardia during laparoscopic cholecystectomies in low-risk patients. Dig Surg 17:513–517CrossRefGoogle Scholar
  11. 11.
    Reed DN Jr, Nourse P (1998) Untoward cardiac changes during CO2 insufflation in laparoscopic cholecystectomies in low-risk patients. J Laparoendosc Adv Surg Tech Part A 8:109–114CrossRefGoogle Scholar
  12. 12.
    DeSouza G, Lewis MC, TerRiet MF (1997) Severe bradycardia after remifentanil. Anesthesiology 87:1019–1020CrossRefGoogle Scholar
  13. 13.
    Reitan JA, Stengert KB, Wymore ML et al (1978) Central vagal control of fentanyl-induced bradycardia during halothane anesthesia. Anesth Analg 57:31–36Google Scholar
  14. 14.
    Shinohara K, Aono H, Unruh GK et al (2000) Suppressive effects of remifentanil on hemodynamics in baro-denervated rabbits. Can J Anesth 47:361–366CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Inbal Dabush-Elisha
    • 1
  • Or Goren
    • 2
  • Aviram Herscovici
    • 3
  • Idit Matot
    • 4
    Email author
  1. 1.Department of AnesthesiologyWolfson Medical CenterHolonIsrael
  2. 2.Division of Anesthesiology and Intensive Care and Pain Medicine, Tel Aviv Sourasky Medical Center, Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Division of Anesthesiology and Intensive Care and Pain Medicine, Tel Aviv Sourasky Medical Center, Sackler School of MedicineTel Aviv UniversityTel AvivIsrael

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