title: An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery.
abstract: Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery. Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully. Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.
authors.affiliation: Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: Ha Son
authors.initials: HS
authors.lastname: Nguyen
authors.affiliation: Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Woehlck
authors.affiliation: Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Neurosurgery, Clement J. Zablocki VA Medical Center, Milwaukee, WI 53295, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Pahapill