Clipping of the appendix induced cardiac arrest during appendectomy under spinal anesthesia.
Bradycardia is commonly seen in high spinal anesthesia, however, evolution of cardiac arrest from sudden onset of severe bradycardia is infrequent. Prompt recognization and resuscitative measures are of paramount importance because they may insure a complete recovery without sequela as an aftermath. We report herein a case of severe sinus bradycardia induced by clipping of the appendix during appendectomy under spinal anesthesia with the sensory block up to T5 dermatome. Prompt intravenous atropine failed to regain normal sinus rhythm, and cardiac arrest ensued. Cardiac massage, manual ventilation with oxygen and low-dose epinephrine successfully resuscitated the patient. The possible mechanisms and management of this complication are also discussed.
Ke
Ya-Ching
YC
Division of Anesthesia, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan, ROC.
Yi
Haun-De
HD
Yang
Chih-Ping
CP
Lee
Hsien-Kuang
HK
Kuo
Chang-Po
CP
Wong
Chih-Shung
CS
D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001062:Appendectomy / Q000009:adverse effects*; D001919:Bradycardia / Q000209:etiology; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012018:Reflex; D014630:Vagus Nerve / Q000502:physiology