Sinus bradycardia and asystole during spinal and epidural anesthesia: a report of 13 cases.
OBJECTIVE
To characterize the clinical features that predispose to sinus bradycardia and cardiac arrest during spinal and epidural anesthesia.


METHODS
Retrospective clinical review.


METHODS
University affiliated medical center.


METHODS
13 patients, aged 26 to 76 years, who suffered severe sinus bradycardia or asystole over a 5-year period, during which approximately 4,000 regional anesthetics were administered.


RESULTS
Case histories of 13 patients who developed severe sinus bradycardia or asystole during spinal or epidural anesthesia are summarized. Twelve cases occurred during spinal anesthesia, and the thirteenth, during epidural anesthesia. In all but one case, the acute event occurred 15 minutes or longer from the time of the anesthetic injection. Resuscitation was successful in all cases, with no postoperative sequelae.


CONCLUSIONS
The clinical picture suggests a reflex cause, possibly associated with low right-sided cardiac filling pressure. No common precipitating cause or high-risk patient profile was noted.
Department of Anesthesiology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135-2997, USA.
B
B
Geffin
L
L
Shapiro
D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001146:Arrhythmia, Sinus / Q000139:chemically induced*; D001919:Bradycardia / Q000139:chemically induced*; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies