Use of head-up tilt testing to determine a possible cause of unexpected cardiac asystole during epidural anesthesia.
Head-up tilt testing is widely used in the diagnosis of syncope of unknown origin. In this report, head-up tilt testing elucidated the etiology of cardiac asystole of unexpected and sudden onset during orthopedic surgery under epidural anesthesia in a 30-year-old woman. Conventional diagnostic approaches were ineffective. Venous pooling in the lower legs as a result of vasodilation and subsequent vagotony due to epidural anesthesia, a condition mimicking orthostatic stress, is proposed as the mechanism of asystole. Follow-up examinations over 16 months revealed no further syncope and a good clinical course. Head-up tilt testing was useful in determining etiology in this case.
Takase
B
B
Department of Internal Medicine, Self Defense Force Central Hospital, Tokyo, Japan.
Goto
T
T
Nagai
T
T
Uehata
A
A
Isojima
K
K
Ohtomi
S
S
Ohta
S
S
Takemoto
T
T
Kurita
A
A
Nakamura
H
H
D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology*; D006339:Heart Rate; D006801:Humans; D009985:Orthopedics; D013575:Syncope / Q000503:physiopathology*; D018667:Tilt-Table Test / Q000379:methods*