A Hypotensive/Bradycardic Episode Leading to Asystole in a Patient Undergoing Shoulder Arthroscopy in the Sitting Position with Interscalene Block and Intravenous Sedation, AANA Journal, February 2016
نویسنده
چکیده
AANA Journal February 2016 Vol. 84, No. 1 27 Anesthesia for shoulder surgery is often accomplished by means of an interscalene block and intravenous sedation, with the patient subsequently placed in the sitting position for surgical access. Despite the advantages of this popular technique, sudden unheralded and severe hypotensive/bradycardic episodes have been reported in this population, with an incidence of 13% to 24%. Although these episodes are usually transient and resolve spontaneously, there are case reports of progression to asystolic cardiac arrest following hypotensive/bradycardic episodes. To raise awareness of the catastrophic potential of these episodes and discuss possible causes and preventive measures, the author presents the case of an ASA class 1 patient undergoing shoulder arthroscopy in the sitting position with an interscalene block and intravenous sedation, who experienced a hypotensive/ bradycardic episode that rapidly progressed to intraoperative asystole.
منابع مشابه
Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks
Sudden, profound hypotensive and bradycardic events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. Although HBEs may be associated with the adverse effects of interscalene brachial plexus block (ISBPB) in the sitting position, the underlying mechanisms responsible for HBEs during the course of shoulder surgery are not well underst...
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Cardiac arrest after interscalene brachial plexus block in the sitting position for shoulder arthroscopy: a case report.
The authors report a case of cardiac arrest following interscalene brachial plexus block in the sitting position for shoulder arthroscopy. The cardiac arrest occurred 45 minutes after interscalene brachial plexus block. It seems that it resulted from the activation of Bezold-Jarisch's reflex and a related vasovagal syncope.
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BACKGROUND Episodes of bradycardia hypotension (BH) or vasovagal syncope have a reported incidence of 13-29% during arthroscopic shoulder surgery in the sitting position after an interscalene block (ISB). This study was designed to investigate whether intravenous fentanyl during shoulder arthroscopy in the sitting position after ISB would increase or worsen the incidence of BH episodes. METHO...
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