title: Asystole developed during total gastrectomy under general anesthesia combined with thoracic epidural anesthesia.
abstract: We report a 73-year-old woman who developed sudden bradycardia and asystole due to vagal reflex during transabdominal total gastrectomy under general anesthesia with thoracic epidural analgesia. General anesthesia was induced with propofol, fentanyl and maintained with sevoflurane and epidural infusion of lidocaine. Severe bradycardia, followed by asystole was detected on electrocardiography 10 minutes after starting surgery, triggered by the retraction of the abdominal wall and intestines. Blood pressure and heart rate recovered in response to atropine, ephedrine and chest compressions in 10 seconds. Surgery was completed uneventfully and the patient was discharged without complications. For preventing life-threatening bradycardia and asystole by vagal reflex, we suggest the use of atropine prior to the operations in patients undergoing abdominal or ophthalmic surgery, where vagal reflex may occur.
authors.affiliation: Department of Anesthesiology, Osaka City General Hospital and Children's Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
authors.forename: Hiroai
authors.initials: H
authors.lastname: Okutani
authors.forename: Ryu
authors.initials: R
authors.lastname: Okutani
authors.forename: Taketo
authors.initials: T
authors.lastname: Nakamura
mesh_terms: D018663:Adrenergic Agents / Q000627:therapeutic use; D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000768:Anesthesia, General / Q000009:adverse effects*; D001794:Blood Pressure; D001919:Bradycardia / Q000209:etiology / Q000503:physiopathology; D016887:Cardiopulmonary Resuscitation; D004562:Electrocardiography; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate; D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D012018:Reflex; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology
chemical_list: D018663:Adrenergic Agents; D018727:Muscarinic Antagonists