# Intraoperative Asystole during Thoracoscopic Left Lung Upper Lobectomy: A Case Report

## TL;DR

This case report describes a rare event of intraoperative asystole during lung surgery, likely caused by a vagal reflex, and highlights the importance of preparedness during such procedures.

## Contribution

The report identifies a vagal reflex as a novel cause of intraoperative asystole during thoracoscopic lobectomy.

## Key findings

- Intraoperative asystole occurred during dissection of the left superior pulmonary vein.
- The asystole resolved spontaneously after ceasing surgical manipulation.
- The event was attributed to a transient vagal reflex rather than cardiac pathology.

## Abstract

Intraoperative asystole is a rare but potentially life-threatening complication of lung cancer surgery. Various factors, including cardiac conditions, hemorrhage, anesthetic effects, and neural reflexes, may contribute to this phenomenon. Herein, we report a case of intraoperative asystole triggered by a vagal reflex during thoracoscopic left upper lobectomy.

A 53-year-old man with left upper lobe adenocarcinoma of the lung (cT1cN0M0, Stage IA3) underwent video-assisted thoracoscopic surgery. During blunt dissection along the posterior surface of the left superior pulmonary vein, severe bradycardia rapidly progressed to asystole. Surgical manipulation was discontinued immediately, and spontaneous circulation returned within 40 s without pharmacological intervention. As the event resolved immediately upon cessation of surgical stimulation, it was considered a transient reflex response. The surgery was resumed and completed without complications. The patient’s postoperative course was uneventful.

Although rare, vagal reflex–induced asystole should be considered during manipulation of the left pulmonary hilum. Therefore, surgeons and anesthesiologists must be vigilant and prepared for immediate resuscitative measures to ensure patient safety.