For a treatment of advanced gastric cancer, the CHPP (Continuous Hyperthermic Peritoneal Perfusion) was often carried out with the surgical procedure. During the CHPP, many cardiovascular changes were occurred.
In this case, ventricular fibrillation was suddenly happened at 21 minutes after the CHPP initiation, so we immediately stopped the CHPP. After we carried out the chest massage, heart rate and blood pressure was normalized. But ECG was revealed
ST
depression & T wave inversion. Therefore, we injected 1% lidocaine 60mg and infused nitroglycerin at a rate of 0.7μg/kg/min. At the end of the surgery, the ECG was nearly normalized.
After this case, we figured out many causes of ventricular fibrillation. First, the patient might had silent myocardial ischemia or coronary arterial disease, but he did not complain any symptoms. Second, peritoneal cavity expander and 8 liters
of
heated perfusate directly compressed his heart and facilitated the myocardial ischemia. So we planned routinely nitroglycerin infusion during the CHPP.
The patient rarely complained chest pain at ward and discharged postoperatively 19 days later.
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