베타 수용체 차단제와 칼슘 통로 차단제를 복용 중인 환자에서 상완신경총 차단 후 지연 발생한 심정지 = Delayed Cardiac Arrest after Brachial Plexus Block in a Patient Taking β-Adrenoreceptor Antagonist and Calcium Channel Blocker

다국어 초록 (Multilingual 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 β-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. (Korean J Anesthesiol 2006; 51: 752～5)

참고문헌 (Reference)

1 "β-adrenergic blockers and vasovagal episodes during shoulder surgery in the sitting position under interscalene block" 88 : 378-381, 1999

2 "Was case report a case of unrecognized local anesthetic toxicity?" 96 : 1844-1845, 2003

3 "Vasovagal cardiac arrest during the insertion of an epidural catheter and before the administration of epidural medication" 86 : 1263-1265, 1998

4 "The use of metoprolol and glycopyrrolate to prevent hypotensive/bradycardic events during shoulder arthroscopy in sitting position under interscalene block" 87 : 1320-1325, 1998

5 "The cardiotoxicity of local anesthetics:The place of ropivacaine" 1 : 207-214, 2001

6 "The autonomic nervous system." Churchill Livingstone Publishers 617-678, 2005

7 "Regional anesthesia and local anesthetic-induced systemic toxicity: Seizure frequency and accompanying cardiovascular changes." 81 : 321-328, 1995

8 "Novel analgesic adjuncts for brachial plexus block:A systematic review" 90 : 1122-1128, 2000

9 "Neurocardiogenic syncope" 44 : 1004-1010, 2004

10 "Drug-induced atrioventricular block:Prognosis after discontinuation of the culprit drug" 44 : 105-108, 2004

11 "Delayed severe bradycardia during epidural anesthesia:A case report" 49 : 538-541, 2005

12 "Current concepts in resuscitation of patients with local anesthetic cardiac toxicity" 27 : 568-575, 2002

13 "Clinical relevance of the Bezold-Jarisch reflex" 98 : 1250-1260, 2003

14 "Clinical anesthesiology" New York,McGraw Hill Press 441-463, 2006

15 "Cardiac arrest after labetalol and metoclopramide administration in a patient with scleroderma" 95 : 1667-1668, 2002

16 "Cardiac arrest after injection of ropivacaine for posterior lumbar plexus blockade" 99 : 1451-1453, 2003

17 "Brachial plexus anesthesia:Essentials of our current understanding" 27 : 402-428, 2002

18 "Anesthesia and co-existing disease" New York,Churchill Livingstone 395-403, 2002

19 "Activation of the Bezold-Jarisch reflex in the sitting position for shoulder arthroscopy using interscalene block" 80 : 1158-1162, 1995