Vasovagal asystole during spinal anaesthesia

Abstract

SummaryA patient in whom vasovagal asystole was induced by the performance of a spinal anaesthetic in the upright position is described. This illustrates the importance of routine monitoring of the electrocardiograph during regional anaesthesia. The risk of vasovagal syncope may be increased by the use of the silting position and by the omission of anxiolytic premedication. Key wordsAnaesthetic techniques, regional; spinal. Complications; as ystole . Case historyA 34-year-old man presented for internal fixation of his left ankle following a fracture. He was physically fit and history and examination were unremarkable. His ankle had been manipulated under general anaesthesia 2 days previously but the fracture alignment was unsatisfactory. The patient complained of nausea after his first anaesthetic, so a spinal anaesthetic was suggested as an alternative for the second procedure. There was a full discussion of risks and side effects. No premedication was given at the patient's request.The arterial blood pressure was measured on arrival in the anaesthetic room (systolic 130 mmHg) and electrocardiograph (ECG) leads attached for continuous monitoring. After subcutaneous infiltration of 1 % lignocaine, a 16-G cannula was inserted into a vein on the left forearm and 500 ml of a crystalloid solution was infused rapidly.The patient was positioned on the trolley sitting upright with his head bent over his knees. Spinal anaesthesia was performed using an aseptic technique. Two ml 1% lignocaine were infiltrated subcutaneously over the L,-, interspace. A 25-G spinal needle was inserted through the skin and spinal ligaments at that level until clear cerebrospinal fluid (CSF) was obtained. Two and a half ml of 0.5% bupivacaine in dextrose was injected into the subarachnoid space. As the injection was being completed, the ECG trace was seen to be flat. The ECG electrodes were still attached to the patient but his eyes were closed, his breathing was stertorous and no peripheral pulse could be palpated. The needle was removed from the patient's back immediately, he was laid supine and oxygen was administered.

Safety and efficacy of spinal vs general anaesthesia in bone marrow harvesting

“…This fact is well known after SPA [5][6][7]12 but it is of greater importance in procedures performed in the prone position such as BMH. Cardiocirculatory depression in this situation must be avoided.…”

“…Several reports have presented cases with cardiopulmonary arrest and resuscitation during SPA. [5][6][7] The present prospective study was designed to evaluate the safety and efficacy of the two different anaesthetic techniques in healthy allogeneic donors undergoing BMH.…”

Ist die Spinalanästhesie bei Eingriffen in Bauchlage ein empfehlenswertes Verfahren?

“…Während vasovagale Synkopen eher während der Durchführung der SPA auftreten [31], ereignen sich Bradykardien oder Asystolien nach erfolgter (hoher thorakaler) Blockade oder Umlagerung des Patienten [34]. Diese entstehen meist durch einen verminderten venösen Rückfluß aufgrund von Vasodilatation und nur in seltenen Fällen durch eine Blockade der Nn.…”

Cardiac arrest after spinal anesthesia in a patient with neurally mediated syncope

“…Because the incidence of NMS is reported to be 3-3.5% [3], we sometimes encounter surgical patients with this disorder. However, severe complications such as cardiac arrest associated with NMS could be rare [2]. We present a case of cardiac arrest after spinal anesthesia in a patient with NMS.…”

“…Other terms have been used to describe this type of syncope including vasovagal syncope and neurocardiogenic syncope [2,3]. Because the incidence of NMS is reported to be 3-3.5% [3], we sometimes encounter surgical patients with this disorder.…”