Korean J Anesthesiol.  2005 Sep;49(3):413-416. 10.4097/kjae.2005.49.3.413.

A Sudden Cardiac Arrest before Spinal Anesthesia of a Diabetic Patient: A case report

• Bak SH
• Lee JH
• Kim HG
• Lee SG
• Ban JS
• Min BW

• KMID: 2299145
• DOI: http://doi.org/10.4097/kjae.2005.49.3.413

Abstract

Vasovagal syncope is elicited by the Bezold-Jarisch reflex, triggered by anxiety, emotional stress or pain. It is the result of reflexively increasing parasympathetic tone and decreasing sympathetic tone sensed by chemoreceptor in vagus nerve and mechanoreceptor of ventricle, which causes bradycardia, systemic vasodilatation and profound hypotension. Although it is a transient episode in many cases, it could give rise to cardiac arrest. Diabetic autonomic neuropathy can lead to significant change in blood pressure and pulse rate, bradycardia, hypotension, and even cardiac arrest by increasing the risk of hemodynamic instability under general or regional anesthesia. We have experienced a patient who had once cardiac arrest following after positional change and recovered in a few minutes. The patient was supposed to have diabetic autonomic neuropathy under the emotional stress and anxiety before spinal anesthesia was done. We believe that this is the result of combination between paradoxical Bezold-Jarisch reflex caused by overactivation of parasympathetic nerve system and autonomic nervous system instability precipitated by diabetic autonomic neuropathy.

Keyword

Bezold-Jarisch reflex; cardiac arrest; diabetic autonomic neuropathy; spinal anesthesia; vasovagal syncope

MeSH Terms

Anesthesia, Conduction
Anesthesia, Spinal*
Anxiety
Autonomic Nervous System
Blood Pressure
Bradycardia
Death, Sudden, Cardiac*
Diabetic Neuropathies
Heart Arrest
Heart Rate
Hemodynamics
Humans
Hypotension
Mechanoreceptors
Reflex
Stress, Psychological
Syncope, Vasovagal
Vagus Nerve
Vasodilation