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Korean Journal of Anesthesiology 2005;49(3):413-416.
DOI: https://doi.org/10.4097/kjae.2005.49.3.413   
A Sudden Cardiac Arrest before Spinal Anesthesia of a Diabetic Patient: A case report.
Sun Ho Bak, Ji Hyang Lee, Hye Gyeong Kim, Sang Gon Lee, Jong Seok Ban, Byung Woo Min
Department of Anesthesiology and Pain Medicine, Fatima Hospital, Daegu, Korea. lovehan3@yahoo.co.kr
Vasovagal syncope is elicited by the Bezold-Jarisch reflex, triggered by anxiety, emotional stress or pain. It is the result of reflexively increasing parasympathetic tone and decreasing sympathetic tone sensed by chemoreceptor in vagus nerve and mechanoreceptor of ventricle, which causes bradycardia, systemic vasodilatation and profound hypotension. Although it is a transient episode in many cases, it could give rise to cardiac arrest. Diabetic autonomic neuropathy can lead to significant change in blood pressure and pulse rate, bradycardia, hypotension, and even cardiac arrest by increasing the risk of hemodynamic instability under general or regional anesthesia. We have experienced a patient who had once cardiac arrest following after positional change and recovered in a few minutes. The patient was supposed to have diabetic autonomic neuropathy under the emotional stress and anxiety before spinal anesthesia was done. We believe that this is the result of combination between paradoxical Bezold-Jarisch reflex caused by overactivation of parasympathetic nerve system and autonomic nervous system instability precipitated by diabetic autonomic neuropathy.
Key Words: Bezold-Jarisch reflex; cardiac arrest; diabetic autonomic neuropathy; spinal anesthesia; vasovagal syncope


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