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: aneet1hotmail.com




INTRODUCTION:

Post operative arrhythmia is a rare complication oI surgery and has been identiIied in 2 oI post
operative patients, 20 in patients who have undergone thoracic surgery and 50 in patients who have
undergone surgery Ior cardiac procedure(1). Arrhythmia is deIined as deviation Irom the normal sinus
rhythm oI the heart .It has been broadly divided into two Iorms tachyarrhythmia and bradyarrhythmia and
it includes ectopic beats , ectopic tachycardia, artial and ventricular Iibrillation 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 oI a 53 year old lady who had been electively posted Ior a laproscopic cholecystectomy.
However during the operative procedure, heamostasis was unachievable and severe heamorrage was
noted Irom the hepatic bed. This indicated Ior an emergency open cholecystectomy to be perIormed on
her. she postoperatively developed arrhythmia under an underlying hypotensive state Ior 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
oI an ectopic beats and begun to have a systolic blood pressure within the range oI 50-70 mmHg that
persisted .It became mandatory Ior us to commence her on ionotropes ( Norepinephrine at a rate oI 16
units per hour ) so as to maintain her systolic and diastolic blood pressure within range .The ECG
remained unequivocal without any signiIicant changes. An ECHO was perIormed and the results showed
a normal study. it was suggested that the operative hypovolumic state oI the patient due to blood loss
could be indicated to have caused the sudden onset oI arrhythmia and this could have Iurther 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 oI the persistent hypotension
that the patient had developed during the post operative stage and its abrupt resolution.


References


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