Korean J Anesthesiol.  2005 Oct;49(4):538-541. 10.4097/kjae.2005.49.4.538.

Delayed Severe Bradycardia during Epidural Anesthesia: A case report

• Lim HK
• Yoo YS
• Lee KH

• KMID: 1936858
• DOI: http://doi.org/10.4097/kjae.2005.49.4.538

Abstract

Severe bradycardia and asystole are uncommon complications during epidural anesthesia but can be life threatening if not properly managed. There are several risk factors including baseline bradycardia, first degree AV block, preoperative beta-blocker, male gender, high sensory block level, and American Society of Anesthesiologists (ASA) physical status class 1. A 48-year-old, ASA class 1, male patient was admitted for the repair of a ventral hernia under epidural anesthesia. Approximately 60 minutes after the epidural anesthesia, heart rate decreased markedly to 10/min without loss of consciousness and a decrease in saturation. The heart rate returned to 90/min after administering atropine. We concluded that severe bradycardia was induced by vagal activation as a result of the low venous return and high sympathetic blockade (T4 sympathetic level).

Keyword

bradycardia; epidural anesthesia; vagal predominance

MeSH Terms

Anesthesia, Epidural*
Atrioventricular Block
Atropine
Bradycardia*
Heart Arrest
Heart Rate
Hernia, Ventral
Humans
Male
Middle Aged
Risk Factors
Unconsciousness
Atropine