title: [Cardiac arrest after epidural anesthesia for a esthetic plastic surgery: a case report].
abstract: Cardiac arrest during neuraxial anesthesia is a serious adverse event, which may lead to significant neurological damage and death if not treated promptly. The associated mechanisms are neglected respiratory failure, extensive sympathetic block, local anaesthetic toxicity, total spinal block, in addition to the growing awareness of the vagal predominance as a predisposing factor. In the case reported, the patient was 25 years old, ASA I, scheduled for aesthetic lipoplasty. After sedation with midazolam and fentany, epidural anesthesia in interspaces T12-L1 and T2-T3 and catheter insertion into inferior puncture were performed. The patient remained in the supine position for 10minutes. Then, she was placed in the prone position, developing asystolic cardiac arrest 20minutes after the completion of neuraxial blockade. The medical team immediately placed the patient in the supine position and began cardiopulmonary resuscitation. Spontaneous circulation was achieved after twenty minutes of resuscitation. We discuss in this report the exacerbated vagal response as the main event mechanism. The patient's successful outcome emphasizes the importance of anaesthetic monitoring by anesthesiologists, prompt recognition and treatment of rhythm changes on the electrocardiogram.
authors.affiliation: Centro de Ensino e Treinamento do Serviço de Anestesia do Ophir Loyola, Belém, PA, Brasil. Electronic address: lari_cardoso@hotmail.com.
authors.forename: Larissa Cardoso
authors.initials: LC
authors.lastname: Pinheiro
authors.affiliation: Centro de Ensino e Treinamento do Serviço de Anestesia do Ophir Loyola, Belém, PA, Brasil.
authors.forename: Bruno Mendes
authors.initials: BM
authors.lastname: Carmona
authors.affiliation: Centro de Ensino e Treinamento do Serviço de Anestesia do Ophir Loyola, Belém, PA, Brasil.
authors.forename: Mário
authors.initials: M
authors.lastname: de Nazareth Chaves Fascio
authors.affiliation: Centro de Ensino e Treinamento do Serviço de Anestesia do Ophir Loyola, Belém, PA, Brasil.
authors.forename: Iris Santos
authors.initials: IS
authors.lastname: de Souza
authors.affiliation: Centro de Ensino e Treinamento do Serviço de Anestesia do Ophir Loyola, Belém, PA, Brasil.
authors.forename: Rui Antonio Aquino
authors.initials: RAA
authors.lastname: de Azevedo
authors.affiliation: Universidade Federal de Alagoas (UFAL), Maceió, AL, Brasil.
authors.forename: Fabiano Timbó
authors.initials: FT
authors.lastname: Barbosa
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D005260:Female; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D015187:Lipectomy
keywords: Anestesia peridural; Cardiac arrest; Epidural anesthesia; Parada cardíaca; Reanimação após peridural; Resuscitation after spinal anesthesia