title: Cardiac arrest due to a vagal reflex potentiated by thoracic epidural analgesia.
abstract: Reflex bradycardia and cardiac arrest may be the result of a vagal reflex, which can occur during a variety of surgical procedures. We report a patient who developed cardiac arrest as a result of a vagal reflex that was potentiated by thoracic epidural analgesia during general anaesthesia. A 53-year-old man was scheduled for subtotal gastrectomy because of an early gastric adenocarcinoma. After an epidural catheter had been inserted, general anaesthesia was induced. During surgery, an abdominal self-retaining retractor was set up but bradycardia and cardiac arrest developed. The patient returned to a normal sinus rhythm after successful resuscitation. We conclude that bradycardia as a result of a vagal reflex is mediated by potent abdominal wall traction and is potentiated by epidural analgesia. Early diagnosis and proper treatment can allow a full recovery, even in high-risk patients.
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea.
authors.forename: J Y
authors.initials: JY
authors.lastname: Park
authors.forename: S J
authors.initials: SJ
authors.lastname: Park
authors.forename: J Y
authors.initials: JY
authors.lastname: Kim
authors.forename: H W
authors.initials: HW
authors.lastname: Shin
authors.forename: H J
authors.initials: HJ
authors.lastname: Lim
authors.forename: J
authors.initials: J
authors.lastname: Kim
mesh_terms: D000005:Abdomen / Q000601:surgery*; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000779:Anesthetics, Local / Q000009:adverse effects*; D017704:Baroreflex / Q000187:drug effects*; D001919:Bradycardia / Q000139:chemically induced / Q000503:physiopathology; D002404:Catheterization / Q000009:adverse effects; D006323:Heart Arrest / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014630:Vagus Nerve / Q000187:drug effects* / Q000503:physiopathology
chemical_list: D000779:Anesthetics, Local