Analysis of factors related to vagally mediated reflex bradycardia during gastrectomy

Abstract

Purpose: Because vagally mediated reflex bradycardia occurs frequently during gastrectomy and is potentially harmful, we compared the incidence of clinically significant reflex bradycardia between patients undergoing laparoscopic gastrectomy (LG) and open gastrectomy (OG) and examined whether the type of surgery (OG vs. LG) was an independent risk factor for clinically significant reflex bradycardia.

Methods: This prospective observational study evaluated 358 adult patients (age 18-70 years) who were undergoing elective OG or LG for gastric cancer resection. Symptomatic reflex bradycardia was defined as a sudden decrease in heart rate to <50 beats per minute (bpm), or to 50-59 bpm with a systolic blood pressure <70 mmHg, associated with a specific surgical maneuver. If bradycardia or hypotension developed, atropine or ephedrine was administered, in accordance with a predefined treatment protocol.

Results: The overall incidence of symptomatic reflex bradycardia was 24.6% (88/358). Univariate analysis revealed the incidence of symptomatic reflex bradycardia in the LG group was significantly lower than that in the OG group [13.0% (13/100) vs. 29.1% (75/258), p = 0.002]. Multivariate logistic regression analysis revealed that the type of surgery (OG vs. LG), advanced age, preoperative bradycardia, type of muscle relaxant (vecuronium vs. rocuronium), no use of intravenous remifentanil, and low core temperature, were independent risk factors for symptomatic reflex bradycardia (odds ratio 3.184; 95% confidence interval 1.490-6.800; p = 0.003).

Conclusion: The LG approach was associated with a reduced risk of clinically significant reflex bradycardia compared with the OG approach.

Keywords: Bradycardia; Gastrectomy; Laparoscopic surgery.