RETRACTED ARTICLE: Sudden cardiac arrest under spinal anesthesia in a mission hospital: a case report and review of the literature

Abstract

BackgroundSudden cardiac arrest following spinal anesthesia is relatively uncommon and a matter of grave concern for any anesthesiologist as well as clinicians in general. There have been, however, several reports of such cases in the literature. Careful patient selection, appropriate dosing of the local anesthetic, volume loading, close monitoring, and prompt intervention at the first sign of cardiovascular instability should improve outcomes. The rarity of occurrence and clinical curiosity of this entity suggest reporting of this unusual and possibly avoidable clinical event.Case presentationWe report the occurrence of unanticipated delayed cardiac arrest following spinal anesthesia in a 25-year-old Cameroonian man. Incidentally, the index patient was successfully resuscitated with timely and appropriate cardiopulmonary resuscitative measures. He went ahead to have emergency open appendectomy with good post-operative outcome and recovery.ConclusionsThe management of such cardiac arrest under spinal anesthesia is very challenging in resource- limited settings such as ours. Anesthetists and clinicians need to be well informed of this grave complication. A good understanding of the physiologic changes caused by spinal anesthesia and its complications, adequate patient selection, respecting the contraindications of the procedure, adequate monitoring, and constant vigilance are of paramount importance to the eventual outcome.

A study of anaesthesia-related cardiac arrest from a Chinese tertiary hospital

“…However, the mechanism that triggers cardiac arrest under spinal anaesthesia remains controversial and unclear. The contribution of intrinsic cardiac mechanisms and autonomic imbalance with the background of parasympathetic predominance might provide a more convincing and physiologic explanation for the occurrence of abrupt severe bradycardia and cardiac arrest under spinal anaesthesia [ 19 , 20 ]. Furthermore, over sedation, respiratory arrest, unintentional total spinal, myocardial infarction and local anaesthetic toxicity might also attribute to the causative factors [ 18 ].…”

“…Furthermore, over sedation, respiratory arrest, unintentional total spinal, myocardial infarction and local anaesthetic toxicity might also attribute to the causative factors [ 18 ]. Fully understanding the physiologic changes caused by spinal anaesthesia and its complications, appropriately selecting patients, respecting the contraindications of the procedure, performing adequate monitoring, and exhibiting constant vigilance are particularly important for the eventual outcome [ 19 , 20 ].…”

Hypoglycemia as a cause of sudden cardiac arrest during cesarean delivery under spinal anesthesia: a case report and review of the literature

“…The causes of sudden cardiac arrest during spinal anesthesia are related to anesthetic procedures, surgical procedures, hypotension, primary cardiac problems, massive pulmonary embolism, hypoglycemia, pathophysiological changes during pregnancy, and other related factors [1][2][3][4][5][6][7][8][9][10]. Here, we tried to consider these as the possible differential diagnosis.…”

“…Therefore, the anesthetic procedure was not likely to cause cardiac arrest. However, giving spinal anesthesia in patients with underlying malnutrition, fasting, and dehydration can lead to cardiac arrest even in anesthetic procedures that are done appropriately [6]. Therefore, identifying these conditions in the patient before administration of spinal anesthesia is always crucial.…”

Paro cardiaco inesperado en unidad de cuidados posanestésico en paciente post esterilización tubárica

“…Los factores para desencadenar un paro cardiaco son sobre sedación, paro respiratorio, anestesia espinal total, infarto de miocardio y toxicidad sistémica por anestésicos locales 5 .…”