When carefully monitored during laparoscopy, cardiac dysrhythmias are noted to occur in 17% to 50% of cases (139,140). Fatal dysrhythmias can occur with marked elevation of PaCO2(41).
Typically, tachycardia and ventricular extrasystoles associated with CO2 stimulation are benign and can be prevented by avoiding excessive hypercapnia.
Hypercapnia potentiates parasympathetic actions in some situations (41). Vagal stimulation by peritoneal manipulation or distention during CO2 laparoscopy can occasionally produce bradydysrhythmias. Asystolic arrest during CO2 laparoscopy has been reported (132,134). Because vagal reactions may be accentuated during awake laparoscopy (local anesthesia), some recommend premedication with atropine in this setting (141).
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