Korean J Anesthesiol.  2012 Mar;62(3):209-219. 10.4097/kjae.2012.62.3.209.

Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks

• Song SY
• Roh WS

• KMID: 2299345
• DOI: http://doi.org/10.4097/kjae.2012.62.3.209

Abstract

Sudden, profound hypotensive and bradycardic events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. Although HBEs may be associated with the adverse effects of interscalene brachial plexus block (ISBPB) in the sitting position, the underlying mechanisms responsible for HBEs during the course of shoulder surgery are not well understood. The basic mechanisms of HBEs may be associated with the underlying mechanisms responsible for vasovagal syncope, carotid sinus hypersensitivity or orthostatic syncope. In this review, we discussed the possible mechanisms of HBEs during shoulder arthroscopic surgery, in the sitting position, under ISBPB. In particular, we focused on the relationship between HBEs and various types of syncopal reactions, the relationship between HBEs and the Bezold-Jarisch reflex, and the new contributing factors for the occurrence of HBEs, such as stellate ganglion block or the intraoperative administration of intravenous fentanyl.

Keyword

Arthroscopy; Bradycardia; Hypotension; Shoulder; Syncope

MeSH Terms

Arthroscopy
Brachial Plexus
Bradycardia
Carotid Sinus
Fentanyl
Humans
Hypersensitivity
Hypotension
Reflex
Shoulder
Stellate Ganglion
Syncope
Syncope, Vasovagal
Fentanyl