Asystole during spinal anaesthesia after change from Trendelenburg to horizontal position

  • Toshiaki Nishikawa
  • Yukinobu Anzai
  • Akiyoshi Namiki
Article
  • 387 Downloads

Abstract

We present a case in which progressive bradycardia and sudden cardiac arrest developed in a 26-year-old healthy woman with an ovarian cyst during spinal anaesthesia, immediately after the patient was moved from the 15° Trendelenburg to the supine horizontal position. We postulate that a decrease in venous return was the main cause of the cardiac arrest. It should be stressed again that close monitoring during spinal anaesthesia is essential when the patient is subjected to postural changes.

Key words

ANAESTHESIA, REGIONAL: spinal COMPLICATIONS: cardiac arrest POSITION: Trendelenburg supine horizontal 

Résumé

On présente le cas ďune bradycardie progressive et ď un arrêt cardiaque lors ďune anesthésie rachidienne chez une patiente âgée de 26 ans présentant un kyste ovarien survenant immédiatement après changement de position ďun Trendelenbourg de 15° à une position horizontale. On pense que la diminution du retour veineux est la cause principale de ľarrêt cardiaque. On doit insister sur le fait qu’une surveillance étroite est nécessaire lors ďune rachi anesthésie quand le patient est asujetti à des changements de position.

References

  1. 1.
    Greene NM. Preganglionic sympathetic blockade in man: a study of spinal anesthesia. Acta Anaesthesiol Scand 1981; 25: 463–9.PubMedGoogle Scholar
  2. 2.
    Wetstone DL, Wong KC. Sinus bradycardia and asystole during spinal anaesthesia. Anesthesiology 1974; 41: 87–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Sancetta SM, Lynn RB, Simeone FA, Scott RW. Studies of hemodynamic changes in humans following induction of low and high spinal anesthesia I. General considerations of the problem. The changes in cardiac output, brachial arterial pressure, peripheral and pulmonary oxygen contents and peripheral blood flows induced by spinal anesthesia in humans not undergoing surgery. Circulation 1952; 6: 559–71.PubMedGoogle Scholar
  4. 4.
    Moore DC, Bridenbaugh LD, Bagdi PA, Bridenbaugh PO, Stander H. The present status of spinal (subarachnoid) and epidural (peridural) block: a comparison of the two technics. Anesth Analg 1968; 47: 40–9.PubMedGoogle Scholar
  5. 5.
    Baron J-F, Decaux-Jacolot A, Edouard A, Berdeaux A, Samii K. Influence of venous return on baroreflex control of heart rate during lumbar epidural anesthesia in humans. Anesthesiology 1986; 64: 188–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Chamberlain DP, Chamberlain BDL. Changes in the skin temperature of the trunk and their relationship to sympathetic blockade during spinal anesthesia. Anesthesiology 1986; 65: 139–43.PubMedCrossRefGoogle Scholar
  7. 7.
    Ecoffey C, Edouard A, Pruszczynski W, Taly E, Samii K. Effects of epidural anesthesia on catecholamines, renin activity, and vasopressin changes induced by tilt in elderly men. Anesthesiology 1985; 62: 294–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Bieniarz J, Crottogini JJ, Curuchet E et al. Aortocaval compression by the uterus in late human pregnancy II. An arteriographic study. Am J Obstet Gynecol 1968; 100: 203–17.Google Scholar
  9. 9.
    Schroeder GM, Jebson PJ. The supine hypotension syndrome in a young boy. Anesthesiology 1986; 64: 377–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Melcher A. Respiratory sinus arrhythmia in man: a study in heart rate regulating mechanisms. Acta Physiol Scand 1976; 435(suppl): 1–31.Google Scholar
  11. 11.
    O‘Rourke GW, Green NM. Autonomic blockade and the resting heart rate. Am Heart J 1970; 80: 469–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Wheeler T, Watkins PJ. Cardiac denervation in diabetes. Br Med J 1973; 4: 584–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Murray A, Ewing DJ, Campbell IW, Neilson JMM, Clarke BF. RR interval variations in young male diabetics. Br Heart J 1975; 37: 882–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Braunwald E. Heart disease. A textbook of cardiovascular medicine. Vol 2. Philadelphia: W.B. Saunders Company. pp. 1447–60, 1980.Google Scholar

Copyright information

© Canadian Anesthesiologists 1988

Authors and Affiliations

  • Toshiaki Nishikawa
    • 1
    • 2
  • Yukinobu Anzai
    • 1
    • 2
  • Akiyoshi Namiki
    • 1
    • 2
  1. 1.Institute of Clinical Medicine, University of TsukubaTsukuba-CityJapan
  2. 2.Department of AnesthesiologySapporo Medical College and HospitalSapporoJapan

Personalised recommendations