- Department of Neurosurgery, Tufts Medical Center, Washington, Boston, United States.
- Department of Anesthesiology, Tufts Medical Center, Washington, Boston, United States.
James Kryzanski, Department of Neurosurgery, Tufts Medical Center, Washington, Boston, United States.
DOI:10.25259/SNI_25_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Caitlin Keenan1, Andy Y. Wang1, Konstantin Balonov2, James Kryzanski1. Postoperative vasovagal cardiac arrest after spinal anesthesia for lumbar spine surgery. 11-Feb-2022;13:42
How to cite this URL: Caitlin Keenan1, Andy Y. Wang1, Konstantin Balonov2, James Kryzanski1. Postoperative vasovagal cardiac arrest after spinal anesthesia for lumbar spine surgery. 11-Feb-2022;13:42. Available from: https://surgicalneurologyint.com/surgicalint-articles/11388/
Background: Spinal anesthesia is being increasingly recognized as a favorable alternative to general anesthesia. However, there are still several considerations for its safe and effective use.
Case Description: A 62-year-old male received spinal anesthesia during an uneventful L3-L5 decompressive laminectomy. However, he subsequently experienced a brief episode of pulseless electrical activity in the post-anesthesia care unit, and was successfully resuscitated without further sequelae. This was attributed to a vasovagal episode, with his notable prior history of experiencing vasovagal syncope with lightheadedness and fainting at the sight of blood.
Conclusion: Patients with a history of vasovagal syncope may be predisposed to experiencing brief potentiated episodes of severe bradycardia and even cardiac arrest following spinal anesthesia.
Keywords: Cardiac arrest, Lumbar spine, Pulseless electrical activity, Spinal anesthesia, Vasovagal
Spinal anesthesia during lumbar surgery is a safe and effective alternative to general anesthesia for patients across a wide range of ages and health statuses.[
A 62-year-old male presented with progressive/severe neurogenic claudication. He had a previous L1 burst fracture with fusion surgery 10 years prior, and now has severe L3/L4 and L4/L5 spinal stenosis on imaging [
Here, we present the case of a 62-year-old male who experienced brief PEA arrest in the PACU after an uneventful lumbar surgery under spinal anesthesia. This episode was attributed to a vasovagal reflex (also known as the BezoldJarisch reflex or neurocardiogenic syncope).[
There is precedent in the literature for patients with a history of vasovagal episodes experiencing similar events under regional anesthesia [
Kinsella et al. offer several suggestions for avoiding vasovagal arrest under spinal anesthesia.[
This case report describes an episode of vasovagal cardiac arrest occurring in the PACU following spinal anesthesia for lumbar stenosis surgery, and we recommend asking patients about their history of vasovagal events to gain some insight into their risk for vasovagal complications such as PEA following spinal anesthesia.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
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