OPERATIVE HYPOVOLAEMIA INDUCED POSTOPERATIVE HYPOTENSION AND ARRHYTHMIA IN A PATIENT UNDERGOING AN OPEN CHOLESYSTECTOMY

Dr Aneet Patel, Dr. Arnab Mohanty, Dr Avinash Sharma, Dr. Rakesh Vakil 2 , Dr. Yoel Paljor 1,

Department of General Surgery , St. Stephens Hospital, New Delhi, India

1.Head of department of General Surgery , St. Stephens Hospital ,New Delhi . 2. Senior Consultant, Department of General Surgery , St. Stephens Hospital New Delhi. Correspondence address: E-Mail: aneet_1@hotmail.com

INTRODUCTION: Post operative arrhythmia is a rare complication of surgery and has been identified in 2% of post operative patients, 20 % in patients who have undergone thoracic surgery and 50 % in patients who have undergone surgery for cardiac procedure(1). Arrhythmia is defined as deviation from the normal sinus rhythm of the heart .It has been broadly divided into two forms tachyarrhythmia and bradyarrhythmia and it includes ectopic beats , ectopic tachycardia, artial and ventricular fibrillation and heart blocks. Arrhythmias can be caused by hypo or hyperkalemia, hypomagnesia, hypocalcaemia , hypercapnia and thyrotoxicosis although other causes can be incited. We report a case of a 53 year old lady who had been electively posted for a laproscopic cholecystectomy. However during the operative procedure, heamostasis was unachievable and severe heamorrage was noted from the hepatic bed. This indicated for an emergency open cholecystectomy to be performed on her. she postoperatively developed arrhythmia under an underlying hypotensive state for next several days. Which resolved abruptly. CASE REPORT. DISCUSSION As mentioned earlier arrhythmia is a known post operative surgical complication, however it has rarely been documented with an underlying hypotensive state .In our condition our patient had an abrupt onset of an ectopic beats and begun to have a systolic blood pressure within the range of 50-70 mmHg that persisted .It became mandatory for us to commence her on ionotropes ( Norepinephrine at a rate of 16 units per hour ) so as to maintain her systolic and diastolic blood pressure within range .The ECG remained unequivocal without any significant changes. An ECHO was performed and the results showed a normal study. it was suggested that the operative hypovolumic state of the patient due to blood loss could be indicated to have caused the sudden onset of arrhythmia and this could have further lead to have caused the hypotension. Studies have indicated that arrhythmia could have been caused by the pre existing hypotension that could have been caused during the hepatic bleeding that occurred during the operative procedure .however we have been unable to establish the cause of the persistent hypotension that the patient had developed during the post operative stage and its abrupt resolution.

References

1.Schwartz principles of surgery , Companion handbook 7th edition , Chapter 11 , Surgical complications , cardiac complications.