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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 도상환, "전신마취에 의해 회복된 자궁내번증" 대한마취통증의학회 47 (47): 284-286, 2004

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

3 McConachie I, "Vasovagal asystole during spinal anaesthesia" 46 : 281-282, 1991

4 Geffin B, "Sinus bradycardia and asystole during spinal and epidural anesthesia: a report of 13 cases" 10 : 278-285, 1998

5 Watkins EJ, "Severe vasovagal attack during regional anaesthesia for caesarean section" 84 : 118-120, 2000

6 Doyle DJ, "Reflex bradycardia during surgery" 37 : 219-222, 1990

7 Huang MH, "Postural position and neurocardiogenic syncope in late pregnancy" 92 : 1252-1253, 2003

8 Chang AB, "Physiologic changes of pregnancy, In Obstetric Anesthesia: Principles and Practice" Elsevier Mosby 18-21, 2004

9 Kinsella SM, "Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex" 86 : 859-868, 2001

10 Hart PS, "Needle phobia and malignant vasovagal syndrome" 53 : 1002-1004, 1998

11 Pollard JB, "Cardiac arrest during spinal anesthesia: common mechanisms and strategies for prevention" 92 : 252-256, 2001

12 Scull TJ, "Cardiac arrest after Caesarean section under subarachnoid block" 77 : 274-276, 1996

13 Coventry DM, "Bradycardia during intraabdominal surgery. Modification by pre-operative anticholinergic agents" 42 : 835-839, 1987

14 Shen CL, "Arrhythmias during spinal anesthesia for Cesarean section" 47 : 393-397, 2000

15 Emmott RS, "Acute inversion of the uterus at caesarean section. Implications for the anaesthetist" 43 : 118-120, 1988