Postoperative transient bradycardia and asystole after bilateral bunionectomies performed using spinal anesthesia

Peripheral or central nerve blocks for foot surgery: a prospective, randomized clinical comparison

“…Medical complications after minor foot procedures are rarely encountered; however, spinal anaesthesia may occasionally result in significant haemodynamic side‐effects, such as transient bradycardia and asystole [10], due to the activation of paradoxical reflexes induced by the sympathetic blockade [11,12]. In the present investigation, we did not report differences in haemodynamic side‐effects among the different anaesthesia techniques; however, it must be considered that this study was not adequately powered to detect differences in the incidence of haemodynamic side‐effects.…”

Bradycardia and asystolic cardiac arrest during spinal anaesthesia: A report of five cases

“…At least 17 sporadic cases of unexpected, primary sinus bradycardia and asystole have been reported ( 3, 4, 10, 13–22) since the dramatic closed‐claims review by Caplan in 1988 ( 2). All except one were successfully resuscitated and did not suffer any sequelae.…”

Reply

“…The review of the literature for the past 11 years (i.e. after the article of Caplan et al ( 5) had been published) reveals that 27 of 29 patients with primary cardiac arrest reported in detail were given hyperbaric solution intraspinally ( 1, 2, 6–16). Only in one case ( 17) was isobaric bupivacaine administered; the baricity of the anaesthetic solution was not stated in the other case ( 18).…”