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Cardiac arrest after spinal anesthesia in a patient with neurally mediated syncope

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Abstract

We present the case of cardiac arrest in a patient with neurally mediated syncope (NMS). A 66-year-old male patient was scheduled to undergo right inguinal hernioplasty. He had a history of syncope, which occurred a few times a year in childhood and once a year recently. One minute after the second spinal injection, cardiac arrest (asystole) developed. Sinus rhythm was restored by cardiac massage and intravenous administration of atropine and ephedrine. The operation was cancelled. The patient was diagnosed as NMS by a cardiologist. Four months later, right inguinal hernioplasty was performed, uneventfully, under general anesthesia. High sympathetic blockade due to spinal anesthesia and transient withdrawal of sympathetic tone and increase in vagal discharge due to NMS could be the main causes of the cardiac arrest. If the patient has any possibility of NMS, anesthesiologists should consider the possibility of cardiac arrest after spinal anesthesia.

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Authors and Affiliations

  1. Surgical Center, University of Yamanashi Hospital, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Tadahiko Ishiyama, Hironobu Iwashita, Taishi Masamune & Masakazu Kotoda

  2. Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Kazuhiro Shibuya, Yoshihide Terada & Takashi Matsukawa

Authors
  1. Tadahiko Ishiyama
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  2. Kazuhiro Shibuya
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  3. Yoshihide Terada
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  4. Hironobu Iwashita
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  5. Taishi Masamune
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  6. Masakazu Kotoda
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  7. Takashi Matsukawa
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Correspondence to Tadahiko Ishiyama.

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Ishiyama, T., Shibuya, K., Terada, Y. et al. Cardiac arrest after spinal anesthesia in a patient with neurally mediated syncope. J Anesth 26, 103–106 (2012). https://doi.org/10.1007/s00540-011-1264-7

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  • DOI: https://doi.org/10.1007/s00540-011-1264-7

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