26 July 2023: Articles
Recurrent Syncope Episodes during Spinal Anesthesia for Perianal Abscess Drainage: A Case Report Emphasizing Pain as a Trigger
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Educational Purpose (only if useful for a systematic review or synthesis)
Junyang Ma E , Xiaoxia Tian B , Liqin Deng A*DOI: 10.12659/AJCR.940391
Am J Case Rep 2023; 24:e940391
Table 1. Overview of reported cases of bradycardia/asystole/syncope occurring with neuraxial anesthesia since the year 2000, including 2 incidents occurring post-operatively and a history of vasovagal episodes in 4 patients.
| Source | Patient characteristics | Medical history | Anesthesia position and blocking level | Symptoms | Duration | Operation | Cause |
|---|---|---|---|---|---|---|---|
| Watkins et al [] (2000)17 | A 29-year-old parturient (158 cm, 70 kg) | Vasovagal syncope during a hot air balloon ride while several hundred feet above the ground | SP; T4 | Dizzy, faint, pale, hypotension (70/35 mmHg) and syncope | 10 min | Cesarean section | Severe vasovagal attack after lidocaine1 mg·kg was injected into the epidural catheter |
| Ou et al [] (2004)18 | A 35-year-old parturient (160 cm, 104 kg) | Gestational diabetes mellitus | LDP; T5 | Heart rate decelerating to 8 beats/min, syncope | 2 min | Cesarean section | Bezold-Jarisch reflex after delivery of the infant and placenta under spinal anesthesia |
| Park et al [] (2010)20 | A 26-year-old parturient (165 cm, 92 kg) | Vasovagal syncope | LDP; T5 | Dizziness, hypotension (89/54 mmHg) | No mention | Cesarean section | Vasovagal syncope after 2% lidocaine 20 ml plus fentanyl 100 μg was injected through the epidural catheter |
| Jang et al [] (2013)19 | A 39-year-old parturient (152 cm, 67 kg) | Self-limited palpitation, non-sustained ventricular arrhythmia, vasovagal syncope | RDP; T3 | Cardiovascular collapse, respiratory arrest, loss of consciousness, asystole | 4 min | Cesarean section | Vasovagal cardiac arrest after the placental expulsion |
| Ishiyama et al [] (2012)21 | A 66-year-old man (165 cm, 55 kg) | Syncope, which occurred a few times a year in the childhood and once a year recently, rheumatoid arthritis | DP; T5 | Lost consciousness and cardiac arrest | 30 s | Right inguinal hernioplasty | Neurally mediated syncope after the spinal anesthesia |
| Alparslan et al [] (2016)22 | A 39-year-old man (175 cm, 76 kg) | No | SP; T10 | Hypotension and dizziness | 3 days | Right inguinal hernioplasty | Vasovagal syncope after spinal anesthesia due to a fear and panic on the first day (post-operative) |
| Makkar et al [] (2018)23 | A 29-year-old man | No | SP; L3 | Dizziness and heart rate fell to 30 | Nomention | Debridement and skin grafting | Vasovagal mediated cardiac arrest during epidural catheter insertion |
| Keenan et al [] (2022)24 | A 62-year-old man | Vasovagal syncope episodes attributed to needles and blood | Nomention | Bradycardia and PEA arrest | 30 s | L3-L5 decompressive laminectomy | Postoperative vasovagal cardiac arrest in post-Anesthesia Care Unit |
| This case | A 44-year-old man (175 cm, 76 kg) | No | SP; S1 | Pale, diaphoretic, transient loss of consciousness and dystonia | 30 s | Drainageof a perianal abscess | During spinal puncture with a 25 G syringe needle under guiding by a 20 G syringe needle |
| DP – decubitus position; LDP – left decubitus position; RDP – right decubitus position; SP – sitting position; PEA – pulseless electrical activity. | |||||||