title: A case of asystole from carotid sinus hypersensitivity during patient positioning for thyroidectomy.
abstract: We present a case of a patient with multinodular goiter disease who suffered asystole during head hyperextension for surgical positioning on the operational table.
  
  
  
  Manipulation of carotid sinus may trigger bradycardia or even asystole even in patients without prior history of carotid sinus hypersensitivity. The time proximity between patient positioning and asystole, the late responsiveness to atropine, the immediate increase of heart rate after head elevation and the lack of any other trigger factor or prior history support the hypothesis of carotid sinus syndrome.
  
  
  
  Head hyperextension during surgical positioning is not only responsible for jeopardizing blood flow to spinal cord and brainstem but may trigger reflexes, as well, even in patients without prior neck pathology.
authors.affiliation: Department of Anaesthesiology, University Hospital of Crete, Heraklion, Crete, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lilitsis
authors.affiliation: Department of Anaesthesiology, University Hospital of Crete, Heraklion, Crete, Greece.
authors.forename: Alexia
authors.initials: A
authors.lastname: Papaioannou
authors.affiliation: Department of Anaesthesiology, University Hospital of Crete, Heraklion, Crete, Greece.
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Hatzimichali
authors.affiliation: Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spyridakis
authors.affiliation: Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece.
authors.forename: Sofia
authors.initials: S
authors.lastname: Xenaki
authors.affiliation: Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Chalkiadakis
authors.affiliation: Department of General Surgery, University Hospital of Crete, Heraklion, Crete, Greece. sofiabecks@yahoo.gr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chrysos
mesh_terms: D002346:Carotid Sinus / Q000503:physiopathology*; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D056888:Patient Positioning / Q000009:adverse effects*; D013965:Thyroidectomy / Q000379:methods*
keywords: Asystole; Hyperextension; Position; Thyroidectomy