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

Ishiyama, Tadahiko; Shibuya, Kazuhiro; Terada, Yoshihide; Iwashita, Hironobu; Masamune, Taishi; Kotoda, Masakazu; Matsukawa, Takashi

doi:10.1007/s00540-011-1264-7

Cited by 7 publications

(4 citation statements)

References 11 publications

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“…Spinal anesthesia is one of the most used anesthetic techniques, believed to be very safe, though severe complications may occur (Ishiyama et al 2012). The first cases of CA occurring after spinal block anesthesia were reported in the 1940s and since then, the ability of spinal anesthesia to cause cardiopulmonary arrest was considered (Arruda et al 2011).…”

Section: Spinal Anesthesia Fatalitiesmentioning

confidence: 99%

Perioperative and anesthetic deaths: toxicological and medico legal aspects

Argo

Zerbo

Lanzarone

et al. 2019

Egypt J Forensic Sci

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Background: Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text: A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms "operative deaths" and "anesthetic deaths" are usually applied inaccurately within the medico-legal literature. Such events involve comprehensively PO fatalities and allow for subtle separation of natural and unnatural death, at least from the prospective of forensic pathology. Iatrogenic deaths in this field can be separated into some major categories, as attributable to previous patient's unfavorable conditions or depending from surgical procedure per se (such as PO cardiac and cerebrovascular events). In this review, the authors carried out syntheses of specific research areas regarding epidemiology, complications of general and spinal anesthetic, failure in airway management and patient's circulatory homeostasis, and adverse drugs reactions; analysis considering the challenge of anesthetic-related mortality, epidemiology and classifications, by indicating causal chain of death, in respect of both contributing and associated anesthetic and surgery facts. Conclusions: Perioperative quality control programs and its relevance for medico-legal evaluation are emphasized as, although mortality rates have decreased worldwide over the last decades, however, preventable drug-related deaths still happen. Such fatal events have to be considered within the field of forensic pathology experts, with regard of malpractice claims, to implement a strategy for preventing potentially fatal complications.

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Section: Spinal Anesthesia Fatalitiesmentioning

confidence: 99%

Perioperative and anesthetic deaths: toxicological and medico legal aspects

Argo

Zerbo

Lanzarone

et al. 2019

Egypt J Forensic Sci

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show abstract

“…Yamaha in a study of the object by subject neurocardioscopic syncope after spinal anesthesia was performed. In this study, one of the causes of syncope, the movement of blood in the lower extremities is expressed, which then activates the sympathetic nervous system and thus severe bradycardia or asystole and syncope occur that cause bradycardia in patients due to the above results, although we can also have multiple causes [24,25].…”

Section: Discussionmentioning

confidence: 95%

The Incidence of Vasovagal Response in Spinal Anesthesia during Surgery

Beiranvand¹

2018

JAICM

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Objective: Vasovagal symptoms for sinus bradycardia are associated with hypotension in spinal anesthesia or immediately after it without the presence of high levels of anesthetic. Imbalance between sympathetic and parasympathetic control of the heart rate can be the cause of this syndrome. Aim of this study, the incidence of vasovagal reflex and its influencing factors in patients undergoing spinal anesthesia were studied. Methods:In this descriptive epidemiological study, 284 patients who were candidates for surgery, under spinal anesthesia which was performed after obtaining written consent. Our study tool was a questionnaire that includes variables such as age, sex, and body mass index, the type of surgery, the anesthesia, fasting time, the positions immediately after spinal anesthesia, ASA class and whether elective or emergency, respectively. Heart and blood pressure were monitored in spinal anesthesia patients. Symptoms of bradycardia and hypotension with loss of consciousness, without anesthesia level above the T10 positively were recorded and the data collected were analyzed with SPSS software. Results:The incidence of vasovagal response in our study population was 4%. In our study between age, sex, BMI, ASA class, anesthesia level S1-S5 and having a history of vasovagal reflex and reflexes shows a significant differences (P<0.05). On the contrary, the type of surgery, duration of fasting before surgery, the patient and the type of positions being elective or emergency surgery, showed that there was no significant relationship (P<0.05). Conclusion:The incidence of vasovagal response in younger people, male as well as people who have a higher BMI is higher. The rate of vasovagal response in patients who have an underlying disease is more. To prevent vasovagal response, measures such as proper hydration before anesthesia, patient monitoring and knowing the history of previous attacks is frequently recommended.

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“…Park et al [ 20 ] reported a case of vasovagal syncope after injecting 20 mL of 2% lidocaine plus 100 µg fentanyl through an epidural catheter. Ishiyama et al [ 21 ] presented a case of neurally mediated syncope following administration of spinal anesthesia. Alparslan et al [ 22 ] discussed a case of vasovagal syncope observed after administration of spinal anesthesia in the sitting position.…”

Section: Discussionmentioning

confidence: 99%

Syncope Due to a Vasovagal Response for Drainage of Perianal Abscess Under Spinal Anesthesia: A Case Report

Ma¹,

Tian²,

Deng³

2023

Am J Case Rep

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Patient: Male, 44-year-old Final Diagnosis: Vasovagal syncope Symptoms: Syncope Clinical Procedure: Spinal anesthesia Specialty: Anesthesiology Objective: Unusual clinical course Background: Vasovagal syncope is a loss of consciousness caused by decreased arterial pressure and cerebral blood flow. The characteristic features of vasovagal syncope include cardiovascular inhibition caused by neural reflexes, accompanied by vasodilation and bradycardia. To date, there is little literature to report several episodes of syncope under spinal anesthesia during the perioperative period for drainage of an anal abscess. The purpose of this article is to alert clinical practitioners to the early identification of the underlying causes of vasovagal syncope and to facilitate timely and effective management strategies. Case Report: We present the case of a 44-year-old man with a perianal abscess who was scheduled for an incision and drainage procedure for the abscess under spinal anesthesia. Preoperative assessment revealed no history of cardiac disease, neurological disorders, or drug allergies. During the perioperative period, the patient experienced 3 episodes of syncope: 1 episode during puncture of spinal anesthesia, and the others at 6.5 h and 8.5 h after the procedure. The patient was discharged 4 days later, and a 30-day postoperative follow-up showed good recovery, without any episodes of syncope. Conclusions: We described a case of 3 episodes of vasovagal syncope occurring in a patient during the perioperative period of drainage of perianal abscess under spinal anesthesia. Pain may have been the main cause of vasovagal syncope in this patient. To avoid vasovagal syncope, it is best for anesthesiologists to choose the lateral position to perform spinal anesthesia and to provide good perioperative pain management for these patients.

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

Cited by 7 publications

References 11 publications

Perioperative and anesthetic deaths: toxicological and medico legal aspects

Perioperative and anesthetic deaths: toxicological and medico legal aspects

The Incidence of Vasovagal Response in Spinal Anesthesia during Surgery

Syncope Due to a Vasovagal Response for Drainage of Perianal Abscess Under Spinal Anesthesia: A Case Report

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