Case of neurocardiogenic syncope with asystole during insertion of epidural catheter

• Published in: Masui. The Japanese journal of anesthesiology Vol. 58; no. 9; p. 1154
• Main Authors: Tajiri, Osamu, Tateda, Takeshi, Ito, Hiroyuki, Yago, Yasuko, Kanazawa, Masashi
• Format: Journal Article
• Language: Japanese
• Published: Japan 01-09-2009
• Subjects: Adult; Anesthesia, Epidural; Anesthesia, General; Anxiety - complications; Atropine - administration & dosage; Female; Fluid Therapy; Heart Arrest - etiology; Heart Arrest - prevention & control; Humans; Intraoperative Care; Intraoperative Complications - etiology; Intraoperative Complications - prevention & control; Midazolam; Monitoring, Intraoperative; Syncope, Vasovagal - etiology; Syncope, Vasovagal - prevention & control
• ISSN: 0021-4892

A 25-year-old healthy woman was scheduled for enucleatic myomectomy under combined epidural and general anesthesia. During insertion of a lumbar epidural catheter, sudden loss of consciousness associated with asystole developed. This condition was quickly restored by rapid fluid infusion, administration of atropine sulfate (0.5 mg) and oxygen (6l x min(-1)). Diagnosis of neurocardiogenic syncope (NCS) was made by previous episodes of fainting revealed at that point. An epidural catheter was placed under sedation with midazolam 2 mg. Surgery was performed uneventfully under sevoflurane anesthesia. Since NCS occurs recurrently in a susceptible individual, it is important to identify previous syncopal episode preoperatively. If such an event is anticipated, prevention including proper communication to reduce patient's anxiety, careful vigilance on both patient and monitor during procedure, gentle maneuver to reduce pain and use sedative and/or anticholinergic agents must be considered.