Patient A
A 59-year-old male (166.5cm, 66.5kg), scheduled for laparoscopic LR because of liver cancer. His results of pre-anesthetic evaluations were in Table 1 (patient A).
Table 1
Results of pre-anesthetic evaluation of two patients
Assessment Item
|
Patient A
|
Patient B
|
American Society of Anesthesiologists (ASA)
|
II
|
II
|
Mallampati Score
|
I
|
I
|
Child-Pugh Classifition
|
A
|
A
|
Metabolic Equivalent (MET)
|
8
|
10
|
Surgical Risk Assessment
|
Medium-high risk
|
Medium risk
|
New York Heart Association (NYHA)
|
I
|
I
|
After careful preanesthetic preparation, general anesthesia was induced with proper dose of midazolam, etomidate, sufentanil and rocuronium. 3 minutes after the induction of anesthesia, a 7.5# tracheal catheter was intubated successfully. The patient was connected to a rebreathing anesthetic circuit with sevoflurane as the inhalant anesthetic and was mechanically ventilated throughout the procedure. Monitoring consisted of continuous electrocardiography (ECG), pulse oxygen saturation (SpO2), continuous arterial blood pressure (ABP), central venous pressure (CVP), bispectral index (BIS), partial pressure of end -tidal carbon dioxide (PetCO2), intermittent arterial blood gas analysis (BGA), urine volume.
IPM was used to control blood loss during the surgery, A 5 minutes of ischemic adaptation period was performed before the first IPM, subsequent IPM ischemia time was controlled within 15 minutes, and the intermediate perfusion period was no less than 10 minutes. IPM is performed by ligation of hepatic arteries and portal veins with aseptic elastic compression bands.
193 minutes after the operation began, ventricular fibrillation was appeared at the time of the third cycle of IPM, which was followed by cardiac arrest in several seconds. Monitoring results of K+, Ca2+ during this period are shown in Fig. 1.
Cardiopulmonary resuscitation (CPR) was initiated immediately, electrical defibrillation, and medication, sinus rhythm was resumed. The patient was successfully rescued after 37 minutes. The monitoring results of K+, PH, lactic acid (Lac) during the 37 minutes shown in Fig. 2. The operation took 5 hours and 50 minutes, and the patient recovered well in 1-month postoperative follow-up.
Patient B
A 44-year-old male (160cm, 55kg), scheduled for laparoscopic LR because of hepatolithiasis. His results of pre-anesthetic evaluations were in Table 1 (patient B).
A same general anesthesia as patient A was conducted for him, and IPM was also used in this surgery.
183 minutes after the operation began, at the fourth time of opening vascular after IPM, ventricular fibrillation appeared, which was followed by cardiac arrest. The manifestations were similar with those of patient A. We did CPR, electrical defibrillation, and medication, and 24 minutes later, he resumed sinus rhythm. Intraoperative parameters were in Fig. 3–4. The operation took 4 hours and 50 minutes, and the patient recovered well in 1-month postoperative follow-up.