1/35. bradycardia and asystolic cardiac arrest during spinal anaesthesia: a report of five cases.Sudden, severe bradycardia/asystolic cardiac arrest are considered infrequent, but are certainly the most serious complications of spinal anaesthesia. We report four cases of primary asystole and one of severe bradycardia in young to middle-aged, healthy patients scheduled for minor surgery at the day surgery unit. bradycardia/asystole were not related to respiratory depression or hypoxaemia/hypercarbia; they occurred at different time intervals after the onset of spinal anaesthesia (10-70 min) and, apparently, were not dependent on the level of sensory block, which varied between T3 and T8. One patient was nauseated seconds before the asystole, otherwise there was no warning signs. All the patients were easily resuscitated with the prompt administration of atropine and ephedrine and, in the case of cardiac arrest, cardiac massage and ventilation with oxygen. One patient was treated with a small dose of adrenaline. Four patients had the surgery, as planned; one had the surgery postponed. All the patients were discharged from hospital in good health and did not suffer any sequelae.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/35. Profound bradycardia and hypotension following spinal anaesthesia in a patient receiving an ACE inhibitor: an important 'drug' interaction?An 86-year-old man on whom a transurethral resection of prostate was performed under spinal anaesthesia developed profound bradycardia and hypotension with disturbance of consciousness during transfer to the recovery room. Initial treatment with atropine produced rapid improvement in cardiovascular and cerebral function. A further hypotensive episode (without bradycardia) occurred approximately 1 h later but responded rapidly to methoxamine. The patient made a full recovery during an overnight stay on the High Dependency Unit. Possible mechanisms for this event are discussed, with the proposal that the concomitant administration of captopril and the relative unavailability of angiotensin ii may have significantly contributed to the problem.- - - - - - - - - - ranking = 0.83333333333333keywords = spinal (Clic here for more details about this article) |
3/35. Hypothalamic encephalitis with bradycardia.A 74-year-old man developed fever, somnolence, hyponatremia, and life-threatening sinus bradycardia for three weeks. He showed a slight elevation of lymphocyte count and protein level in the cerebrospinal fluid. A brain CT scan revealed a diffuse low density area around the hypothalamus which was identified as a high intensity signal by flair MR imaging. Marked sinus bradycardia developed with no abnormality in the echocardiograph or cardiac enzymes. Over the next 6 weeks he became alert and normal sinus rhythm resumed. The results of endocrine tests were compatible with hypothalamic insufficiency with partial hypopituitarism and the syndrome of inappropriate secretion of ADH.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
4/35. Acute hypotension and bradycardia by medulla oblongata compression in spinal surgery.A 71-year-old man was admitted to the hospital with subarachnoid hemorrhage caused by a cervical dural arteriovenous shunt. During surgery, the patient developed acute hypotension and bradycardia, probably caused by surgical compression of the medulla oblongata. During posterior fossa and upper cervical surgery, monitoring cardiovascular, respiratory, and evoked potential parameters is advocated. In the current case, only cardiovascular monitoring detected alteration of brain stem function. Anesthesiologists should be aware that surgical manipulation of the dorsal medulla might cause hemodynamic changes and expose patients to danger. Through close cardiovascular monitoring we can rapidly detect changes in vital signs, which allows prompt intervention to prevent irreversible neurologic deficits and potentially catastrophic patient outcome.- - - - - - - - - - ranking = 0.66666666666667keywords = spinal (Clic here for more details about this article) |
5/35. Wenckebach type heart block following spinal anaesthesia for caesarean section.A case is described of complete heart block during spinal anaesthesia for Caesarean section in a fit 23 yr-old-woman. This developed shortly after the institution of the block, with the height of the block below T5 and in the absence of hypotension. The patient was resuscitated successfully with vagolytic and alpha-agonist drugs. A Wenckebach block persisted for a short period postoperatively. The importance of instituting monitoring before the beginning of anaesthesia and the immediate availability of atropine and alpha-agonists before the initiation of spinal anaesthesia is stressed.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
6/35. Use of aminophylline in the treatment of severe symptomatic bradycardia resistant to atropine.bradycardia and cardiac arrest are known complications of acute spinal cord injuries and are usually temporary. If the general measures of correcting hypoxia and using atropine fail, placement of a temporary followed by a permanent pacemaker is typically considered. We describe 2 very interesting cases of severe symptomatic bradycardia resistant to atropine, where we were able to obviate the use of pacemaker placement by the simple use of intravenous aminophylline. aminophylline had been used in the past for treating resistant bradycardia in settings such as acute inferior wall myocardial infarction, cardiac transplantation, and so on, but has never been used in the setting of acute spinal cord injuries. aminophylline probably works in this setting by increasing cyclic adenosine monophosphate (cAMP) and activating the sympathoadrenal system.- - - - - - - - - - ranking = 0.33333333333333keywords = spinal (Clic here for more details about this article) |
7/35. Occurrence of the Bezold-Jarisch reflex during cesarean section under spinal anesthesia--a case report.We report a 35-year-old parturient with gestational diabetes mellitus (GDM) history who sustained a nearly fatal Bezold-Jarisch reflex during cesarean section under spinal anesthesia. A high spinal block combined with acute massive hemorrhage may produce life-threatening Bezold-Jarisch reflex which should be treated prophylactically and aggressively during surgery. Additionally, the autonomic disturbance associated with GDM might exaggerate the reflex in this episode. The patient survived after successful resuscitation and was discharged without any sequela.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
8/35. Severe maternal bradycardia and asystole after combined spinal-epidural labor analgesia in a morbidly obese parturient.Serious maternal bradycardia and asystole in laboring parturients after combined spinal-epidural labor analgesia are rare. We report such a case in a morbidly obese laboring parturient after receiving combined spinal-epidural labor analgesia. The differential diagnosis, risk factors, potential contributing factors, and the successful management of the complications with our positive patient outcome are discussed. Even with the low dose of neuraxial drugs commonly administered in combined spinal-epidural labor analgesia, this case underscores the importance of vigilance, frequent monitoring, proper positioning, and rapid resuscitation with escalating doses of ephedrine, atropine, and epinephrine, all of which are essential in the presence of bradycardia or asystole in these patients.- - - - - - - - - - ranking = 1.1666666666667keywords = spinal (Clic here for more details about this article) |
9/35. The falcine trigeminocardiac reflex: case report and review of the literature.BACKGROUND: Trigeminocardiac reflex (TCR), the reproducible hypotension and bradycardia upon stimulation of the trigeminal nerve, has been reported during craniofacial surgery and during surgery within the cerebellopontine angle, petrosal sinus, orbit, and trigeminal ganglion. Whereas the falx cerebri is known to be innervated by the nervus tentorii, a recurrent branch of V1, there have been no reports to date of this response upon mechanical stimulation of the falx. CASE DESCRIPTION: We report a case of immediate, reproducible, and reflexive response of asystole upon stimulation of the falx cerebri during operative resection of a parafalcine meningioma in a 53-year-old woman. Upon recognition of the reproducible relationship between falcine stimulation and increased vagal tone, the patient was given glycopyrrolate in an effort to block cholinergic hyperactivity. After glycopyrrolate was given, no further dysrhythmias occurred. CONCLUSION: In this patient, mechanical stimulation of the falx likely resulted in the hyperactivity of the trigeminal ganglion, thereby triggering TCR. The dorsal region of the spinal trigeminal tract includes neurons from hypoglossal and vagus nerves, and projections have been seen between the vagus and trigeminal nuclei. The vagus provides parasympathetic innervation to the heart, vascular smooth muscle, and abdominal viscera. Vagal stimulation via these connections after trigeminal nerve activation likely accounts for the reflexive response of asystole seen in this patient. This is confirmed by the observation that the reflex was inhibited by the anticholinergic effects of glycopyrrolate. awareness of TCR allows for early detection and appropriate treatment.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
10/35. Transient tetraplegia after cervical facet joint injection for chronic neck pain administered without imaging guidance.We report about a patient in whom transient tetraplegia with intact proprioception occurred immediately after infiltration of a facet joint at the C6 level guided by anatomical landmarks. After positioning the patient supine and applying atropine and oxygen, respiration and circulation were stable and all symptoms resolved within the next 30 min. The type of neurological pattern and the course of disease suggest an inadvertent injection into a cervical radicular artery that reinforces the anterior spinal artery. This complication is potentially serious and may be permanently disabling or life threatening. It should be considered by any clinician performing "blind" zygapophysial joint injections in the cervical spine. Using imaging guidance should help prevent this type of complication.- - - - - - - - - - ranking = 0.16666666666667keywords = spinal (Clic here for more details about this article) |
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