Korean J Anesthesiol.  2006 Dec;51(6):752-755. 10.4097/kjae.2006.51.6.752.

Delayed Cardiac Arrest after Brachial Plexus Block in a Patient Taking a beta-Adrenoreceptor Antagonist and Calcium Channel Blocker: A case report

• Lee JY
• Lee HS
• Park SH
• Gill HJ
• Lee SW
• Kim SH
• Chung KH
• Kim MS
• Lee HR

• KMID: 2243615
• DOI: http://doi.org/10.4097/kjae.2006.51.6.752

Abstract

A Bezold-Jarisch reflex (BJR) mediated vasovagal syncope is the most common neurally mediated reflex characterized by the sudden failure of the autonomic nervous system and have been reported in patients undergoing a peripheral nerve block. The concomitant administration of a beta-adrenoreceptor antagonist and calcium channel blocker have a synergistic suppressant effect on the autonomic nervous system and interact with the anesthetics significantly. We report a case of a 57-year-old female patient with essential hypertension controlled with lercanidipine and carvedilol. Cardiac arrest developed with spontaneous respiration 50 min after the brachial plexus block to remove a plate in the humerus. Epinephrine was administered and the pulse immediately returned to a normal sinus rhythm. This event might be vasovagal syncope mediated by BJR, and realted to the antihypertensive medication used.

Keyword

beta-adrenoreceptor antagonist; brachial plexus block; calcium channel blocker; cardiac arrest; vasovagal syncope

MeSH Terms

Anesthetics
Autonomic Nervous System
Brachial Plexus*
Calcium Channels*
Calcium*
Epinephrine
Female
Heart Arrest*
Humans
Humerus
Hypertension
Middle Aged
Peripheral Nerves
Reflex
Respiration
Syncope, Vasovagal
Anesthetics
Calcium
Calcium Channels
Epinephrine