Cardiac asystole during creation of a retroperitoneal working space with a balloon dissector in retroperitoneal laparoscopic nephrectomy: a case report

Abstract Background Although cardiac asystole during balloon dilation to create a retroperitoneal working space has been reported in endoscopic extraperitoneal radicalprostatectomy, it is quite rare during retroperitoneal nephrectomy. We report such a case. Case presentation An 84-year-old woman underwent retroperitoneal laparoscopic nephrectomy under general anesthesia. After positioning in the right flank position, hypotension with bradycardia occurred and was treated using ephedrine and phenylephrine. During balloon inflation to create the retroperitoneal working space, asystole occurred, which lasted for 14 s, followed by a single heartbeat and another 6.2 s of asystole, after which spontaneous circulation was restored. The surgery was completed uneventfully thereafter. Conclusions Reduced venous return caused by the flank position and balloon compression, together with triggering of the vagal reflex by retroperitoneal distention, may contribute to development of asystole during retroperitoneal space creation. Persistent hypotension and bradycardia before balloon dilation may be important warning signs of impending cardiovascular collapse.