Severe pre-operative sinus bradycardia improved by mediastinal lymph node dissection
Abstract Background We report a case of bradycardia improved by surgical resection of the paratracheal lymph nodes, which has rarely been reported in the literature. Case presentation A 41-year-old male patient with pre-operative sinus bradycardia was diagnosed with right upper lobe adenocarcinoma....
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-022-01547-6 |
| _version_ | 1818356814267285504 |
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| author | Jin Wei Ling Yu Nan Wu Hongyu Tan |
| author_facet | Jin Wei Ling Yu Nan Wu Hongyu Tan |
| author_sort | Jin Wei |
| collection | DOAJ |
| description | Abstract Background We report a case of bradycardia improved by surgical resection of the paratracheal lymph nodes, which has rarely been reported in the literature. Case presentation A 41-year-old male patient with pre-operative sinus bradycardia was diagnosed with right upper lobe adenocarcinoma. He planned to undergo VATS right upper lobectomy and mediastinal lymph node dissection. Consultation indicated that there was no need to place a temporary pacemaker. Severe sinus bradycardia occurred during induction of anesthesia and heart rate (HR) fell significantly from 52 to 28 bpm. There was no response to atropine. Isoproterenol was administered continuously for two hours at 0.01 µg per kg per minute to keep the patient’s HR around 50 bpm. During the operation, it was noted that the right upper mediastinal lymph nodes (group R2 and R4) were calcified and very close to the vagus nerve. After resection of the lymph nodes, the patient’s HR returned to 60–68 bpm without isoproterenol. There were no post-operative complications and the patient was discharged on the 5th post-operative day. The pathological findings indicated invasive adenocarcinoma with no lymph node metastases. One month after surgery, 24-h Holter monitoring revealed sinus rhythm without bradycardia. Six months after surgery no sinus bradycardia has occurred thus far. Conclusions Patients with persistent sinus bradycardia pre-operation caused by vagus nerve compression deserve attention. Guidelines on placement of temporary pacemakers and intraoperative anesthesia management may be improved by additional clinical experience. |
| first_indexed | 2024-12-13T20:03:11Z |
| format | Article |
| id | doaj.art-8e67b0ce509f46daa8e8094240747ce7 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-13T20:03:11Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-8e67b0ce509f46daa8e8094240747ce72022-12-21T23:33:06ZengBMCBMC Surgery1471-24822022-03-012211410.1186/s12893-022-01547-6Severe pre-operative sinus bradycardia improved by mediastinal lymph node dissectionJin Wei0Ling Yu1Nan Wu2Hongyu Tan3Department of Anesthesiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & InstituteDepartment of Anesthesiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & InstituteDepartment of Thoracic Surgery II, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & InstituteDepartment of Anesthesiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & InstituteAbstract Background We report a case of bradycardia improved by surgical resection of the paratracheal lymph nodes, which has rarely been reported in the literature. Case presentation A 41-year-old male patient with pre-operative sinus bradycardia was diagnosed with right upper lobe adenocarcinoma. He planned to undergo VATS right upper lobectomy and mediastinal lymph node dissection. Consultation indicated that there was no need to place a temporary pacemaker. Severe sinus bradycardia occurred during induction of anesthesia and heart rate (HR) fell significantly from 52 to 28 bpm. There was no response to atropine. Isoproterenol was administered continuously for two hours at 0.01 µg per kg per minute to keep the patient’s HR around 50 bpm. During the operation, it was noted that the right upper mediastinal lymph nodes (group R2 and R4) were calcified and very close to the vagus nerve. After resection of the lymph nodes, the patient’s HR returned to 60–68 bpm without isoproterenol. There were no post-operative complications and the patient was discharged on the 5th post-operative day. The pathological findings indicated invasive adenocarcinoma with no lymph node metastases. One month after surgery, 24-h Holter monitoring revealed sinus rhythm without bradycardia. Six months after surgery no sinus bradycardia has occurred thus far. Conclusions Patients with persistent sinus bradycardia pre-operation caused by vagus nerve compression deserve attention. Guidelines on placement of temporary pacemakers and intraoperative anesthesia management may be improved by additional clinical experience.https://doi.org/10.1186/s12893-022-01547-6Lung cancerSevere sinus bradycardiaMediastinal lymph node dissectionVagus nerve |
| spellingShingle | Jin Wei Ling Yu Nan Wu Hongyu Tan Severe pre-operative sinus bradycardia improved by mediastinal lymph node dissection BMC Surgery Lung cancer Severe sinus bradycardia Mediastinal lymph node dissection Vagus nerve |
| title | Severe pre-operative sinus bradycardia improved by mediastinal lymph node dissection |
| title_full | Severe pre-operative sinus bradycardia improved by mediastinal lymph node dissection |
| title_fullStr | Severe pre-operative sinus bradycardia improved by mediastinal lymph node dissection |
| title_full_unstemmed | Severe pre-operative sinus bradycardia improved by mediastinal lymph node dissection |
| title_short | Severe pre-operative sinus bradycardia improved by mediastinal lymph node dissection |
| title_sort | severe pre operative sinus bradycardia improved by mediastinal lymph node dissection |
| topic | Lung cancer Severe sinus bradycardia Mediastinal lymph node dissection Vagus nerve |
| url | https://doi.org/10.1186/s12893-022-01547-6 |
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