Asystole during manipulation with a curved-blade laryngoscope and tracheal intubation in patient with a history of syncope: A case report

Park, Chang Hyun; Kwon, Young Eun; Song, Dong Un; Lee, Ki Hyun; Song, Jae Wook

Case Report

Cardiothoracic and Vascular Anesthesia

Anesthesia and Pain Medicine 2012;7(4):325-328.
Published online October 31, 2012.

Asystole during manipulation with a curved-blade laryngoscope and tracheal intubation in patient with a history of syncope: A case report

Chang Hyun Park, Young Eun Kwon, Dong Un Song, Ki Hyun Lee, Jae Wook Song

Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea. anes8838@lycos.co.kr

Abstract

Vagal reflex during manipulation with a curved-blade laryngoscope and tracheal intubation may result in severe bradycardia and even, asystole. Manipulation with laryngoscope and tracheal intubation leaded to bradycardia and asystole at a 47-year-old woman during induction of anesthesia with propofol, remifentanil and cisatracurium and sevoflurane inhalation. Withdrawal of laryngoscope and atropine 0.5 mg injection, her heart rate was recovered to normal sinus rhythm. Intubation at secondary trial was done with bradycardia and heart rate was returned to normal sinus rhythm soon. She had a history of syncope in interview after surgery and was examined tilt test to find of cause of syncope. Although the result of the test was negative, the bradycardia and asystole seemed to be caused by vagal reflex.

Key Words: Asystole, Bradycardia, Syncope, Tracheal intubation, Vagal reflex