Korean J Anesthesiol.  2013 Jan;64(1):77-81. 10.4097/kjae.2013.64.1.77.

Vasovagal cardiac arrest during spinal anesthesia for Cesarean section: A case report

• Jang YE
• Do SH
• Song IA

• KMID: 2236240
• DOI: http://doi.org/10.4097/kjae.2013.64.1.77

Abstract

The vasovagal response is characterized by an inappropriate combination of bradycardia and paradoxical vasodilation. During a general or neuraxial anesthesia-induced sympathectomy, a sudden vagal activation and/or an acute reduction in sympathetic tone can cause serious vasovagal responses. Neuraxial anesthesia for Cesarean section may trigger vasovagal response, due to multiple risk factors; high neuraxial block, sudden hemorrhage, aortocarval compression, peritoneal manipulation, and emotional stress. A 39-year-old pregnant woman, at 38 weeks of gestation with episodes of non-sustained ventricular arrhythmia and newly developed vasovagal syncope during pregnancy, was scheduled to undergo a spinal anesthesia for an elective Cesarean section. Immediately after the placental expulsion, a sudden severe bradycardia, followed by a cardiac arrest occurred. The patient fully recovered after prompt cardiopulmonary resuscitation with chest compression, manual ventilation with oxygen, rapid injection of epinephrine and hydration. This case illustrates a serious potential risk of vasovagal response superimposed on neuraxial anesthesia, during a Cesarean section, especially during placental expulsion.

Keyword

Anesthesia; Cesarean section; Heart arrest; Spinal; Syncope; Vasovagal

MeSH Terms

Anesthesia
Anesthesia, Spinal
Arrhythmias, Cardiac
Bradycardia
Cardiopulmonary Resuscitation
Cesarean Section
Epinephrine
Female
Heart Arrest
Hemorrhage
Humans
Oxygen
Pregnancy
Pregnant Women
Stress, Psychological
Sympathectomy
Syncope
Syncope, Vasovagal
Thorax
Vasodilation
Ventilation
Epinephrine
Oxygen