| Delayed Severe Bradycardia during Epidural Anesthesia: A case report. |
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Hyun Kyo Lim, Young Soo Yoo, Kwang Ho Lee |
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Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. khlee@wonju.yonsei.ac.kr |
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| Abstract |
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Severe bradycardia and asystole are uncommon complications during epidural anesthesia but can be life threatening if not properly managed. There are several risk factors including baseline bradycardia, first degree AV block, preoperative beta-blocker, male gender, high sensory block level, and American Society of Anesthesiologists (ASA) physical status class 1. A 48-year-old, ASA class 1, male patient was admitted for the repair of a ventral hernia under epidural anesthesia. Approximately 60 minutes after the epidural anesthesia, heart rate decreased markedly to 10/min without loss of consciousness and a decrease in saturation. The heart rate returned to 90/min after administering atropine. We concluded that severe bradycardia was induced by vagal activation as a result of the low venous return and high sympathetic blockade (T4 sympathetic level). |
| Key Words:
bradycardia; epidural anesthesia; vagal predominance |
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