Symptomatic (Hypotensive) Bradycardia During Laparoscopic Living Donor Hepatectomy: Incidence and Risk Factors Eun Kyung Lee, Jeayoun Kim, Justin Sangwook Ko, Mi Sook Gwak, and Gaabsoo Kim* Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ABSTRACT Background. The use of a minimally invasive laparoscopic approach in living donor hepatectomy is increasing with the need for enhanced management of living donors. Hy- potensive bradycardia often occurs during abdominal surgery and can be fatal without proper management. We conducted a retrospective study to investigate the incidence and risk factors of symptomatic (hypotensive) bradycardia in laparoscopic living donor hepatectomy. Methods. Hypotensive bradycardia is defined as the heart rate below 60 beats per minute with simultaneous mean arterial blood pressure (MAP) below 65 mm Hg. Clinical char- acteristics of liver donors were collected and analyzed from May 2018 to July 2019. Results. This study included 129 cases of living donor hepatectomy; 11 donors of open hepatectomy were excluded, and 118 donors undergoing laparoscopic hepatectomy were analyzed. Hypotensive bradycardia was shown in 27 donors. Hypertension or angiotensin receptor blocker medication were significantly related to hypotensive bradycardia. Hypo- tensive bradycardia occurred after incision in 22 donors, and the onset time from the incision was 7.5 minutes [first quartile (Q1) 5.75, third quartile (Q3) 11.5, range 0-25], the minimum heart rate was 48.5 beats per minute (Q1 41.5, Q3 53.25, range 25-57), and the minimum MAP was 55 mm Hg (Q1 45, Q3 57.5, range 35-63). It took 132 seconds (Q1 42, Q3 189, range 12-408) to recover MAP over 65 mm Hg. Conclusions. Hypotensive bradycardia occurred in 22.9% of the laparoscopic living donor hepatectomy cases, and 80.6% of cases occurred after incision. Thorough preop- erative evaluation and close monitoring is important even in a healthy donor. L IVER transplantation is a life-saving therapy for patients with end-stage liver disease. Because of the shortage of deceased donor liver grafts, living donor liver transplantation has become a reasonable treatment option. Donor safety is a major concern because donors are otherwise healthy individuals; therefore, previous studies have focused on reducing complications [1,2]. Surgical techniques evolved to favor laparoscopic living donor hep- atectomy because it is less invasive and has improved out- comes, better pain management, a cosmetic benefit, and shortened recovery period [2e4]. As in donor open hepatectomy, it is important to main- tain hemodynamic stability during laparoscopic living donor hepatectomy. Bradycardia is relatively common during general anesthesia [5]. Severe bradycardia can cause cardiac arrest [6], and sustained bradycardia with hypotension can be associated with stroke [7]. In this study, we investigated the incidence of symptomatic (hypotensive) bradycardia in laparoscopic living donor hepatectomy and analyzed the risk factors of hypotensive bradycardia. *Address correspondence to Gaabsoo Kim, Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, 06351, Seoul, Republic of Korea. Tel: þ82-2- 3410-0360; Fax: þ82-2-3410-0361. E-mail: gskim@skku.edu 0041-1345/20 https://doi.org/10.1016/j.transproceed.2020.01.161 ª 2020 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 1788 Transplantation Proceedings, 52, 1788e1790 (2020)