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Obesity Surgery

, Volume 19, Issue 2, pp 253–256 | Cite as

Cardiac Arrest After Intragastric Balloon Insertion in a Super-Obese Patient

  • Lucia CubattoliEmail author
  • Chiara Barneschi
  • Egidio Mastrocinque
  • Paola Bonucci
  • Pier Paolo Giomarelli
Case Report

Abstract

A super-obese patient who suffered from severe sleep apnea (SSA) and other comorbidities underwent insertion of a BioEnterics intragastric balloon (BIB) before bariatric surgery. During the night, he was victim of cardiac arrest. After cardiopulmonary resuscitation and return of spontaneous circulation, he was transferred to intensive care unit. Two hours later, he developed an unexpected symptomatic bradycardia, and BIB was removed. The patient had no further cardiac complications, but he had a poor neurological outcome. In our opinion, such a severe cardiac event was the result of several causes. The BIB induces vagal nerve activation by stretching the gastric wall. In addition, super-obese patients with sleep apnea and other comorbitities have an increased risk of potentially fatal cardiac arrhythmias especially during the night. For all these reasons, we think that these patients may benefit from further preoperative cardiac investigations and a more intensive control during the first postinsertion day.

Keywords

Intragastric balloon Super-obese patient Cardiac arrest 

Notes

Acknowledgments

We would like to thank Mr M. Ballerini, Technical of Neurophysiopatology Department of Neuroscience, for his professional aid and his availability and Dr S. Rossi Department of Neuroscience-University of Siena; without the help of the previous neurological monitoring could not have been possible.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References

  1. 1.
    Doldi SB, Micheletto G, Perrini MN, et al. Intragastric balloon: another option for treatment of obesity and morbid obesity. Hepatogastroenterology. 2004;51:294–7.PubMedGoogle Scholar
  2. 2.
    Fernandez AZ Jr, DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18:193–7.CrossRefGoogle Scholar
  3. 3.
    Spyropoulos C, Katsakoulis E, Vagenas K, et al. Intragastric balloon for high-risk super-obese patients: a prospective analysis of efficacy. Surg Obes Relat Dis. 2007;3:78–83.CrossRefGoogle Scholar
  4. 4.
    Hickey RW, Kochanek PM, Ferimer H, et al. Induced hyperthermia exacerbates neurologic neuronal histologic damage after asphyxial cardiac arrest in rats. Crit Care Med. 2003;31:531–5.CrossRefGoogle Scholar
  5. 5.
    Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out of hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–56.CrossRefGoogle Scholar
  6. 6.
    Madl C, Grimm G, Kramer L, et al. Early prediction of individual outcome after cardiopulmonary resuscitation. Lancet. 1993;341:855–8.CrossRefGoogle Scholar
  7. 7.
    Koenig MA, Kaplan PW, Thakor NV. Clinical neurophysiologic monitoring and brain injury from cardiac arrest. Neurol Clin. 2006;24(1):89–106.CrossRefGoogle Scholar
  8. 8.
    Totté E, Hendrickx L, Pauwels M, et al. Weight reduction by means of intragastric device: experience with the Bioenterics intragastric balloon. Obes Surg. 2001;11:519–23.CrossRefGoogle Scholar
  9. 9.
    Genco A, Bruni T, Doldi SB, et al. BioEnterics intragastric balloon: the Italian experience with 2,515 patients. Obes Surg. 2005;15:1161–4.CrossRefGoogle Scholar
  10. 10.
    Timna N, Pomerantz I, Konikoff F. Intra gastric balloon for morbid obesity. Harefuah. 2006;145(11):826–30, 861.PubMedGoogle Scholar
  11. 11.
    Sallet JA, Marchesini JB, Paiva DS, et al. Brazilian multicenter study of the intragastric balloon. Obes Surg. 2004;14:991–8.CrossRefGoogle Scholar
  12. 12.
    Calle EE, Thun MJ, Petrelli JM, et al. Body mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341:1097–115.CrossRefGoogle Scholar
  13. 13.
    Narkiewicz K, van de Borne PJ, Pesek CA, et al. Selective potentiation of peripheral chemoreflex sensitivity in obstructive sleep apnea. Circulation. 1999;99:1183–9.CrossRefGoogle Scholar
  14. 14.
    Bounhoure JP, Galinier M, Didier A, et al. Sleep apnea syndromes and cardiovascular disease. Bull Acad Natl Med. 2005;189(3):445–59.PubMedGoogle Scholar
  15. 15.
    Zipes D. Autonomic modulation of cardiac arrhythmias. In: Jalife J, Zipes DP, editors. Cardiac electrophysiology: from cell to bedside. 2nd ed. Philadelphia: WB Saunders; 1995. p. 441–54.Google Scholar
  16. 16.
    Gami AS, Howard DE, Olson EJ, et al. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352:1206–14.CrossRefGoogle Scholar
  17. 17.
    Gami AS, Pressman G, Caples SM, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;110(4):364–7.CrossRefGoogle Scholar
  18. 18.
    Grimm W, Koehler U, Fus E, et al. Outcome of patients with sleep apnea-associated severe bradyarrhythmias after continuous positive airway pressure therapy. Am J Cardiol. 2000;86(6):688–92, A9.CrossRefGoogle Scholar
  19. 19.
    Pugliesi F, Captano P, Veneziani N, et al. Tachyarrhythmia due to atrial fibrillation in an intragastric balloon carrier: coincidence or consequence? Obes Surg. 2005;15:716–8.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Lucia Cubattoli
    • 1
    Email author
  • Chiara Barneschi
    • 1
  • Egidio Mastrocinque
    • 1
  • Paola Bonucci
    • 1
  • Pier Paolo Giomarelli
    • 1
  1. 1.Department of Anesthesia and Intensive CareAUOS-University of SienaSienaItaly

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