Intraoperative psychological intervention successfully resolved an acute panic attack within eight minutes during spinal anesthesia, allowing surgery to proceed without conversion to general anesthesia.
Case Report (n=1)
No
Does immediate bedside psychological intervention resolve acute panic attacks in a patient undergoing spinal anesthesia?
Brief psychological intervention can successfully manage acute intraoperative panic attacks during spinal anesthesia, avoiding the need to convert to general anesthesia.
Spinal anesthesia is widely used for lower abdominal and orthopedic procedures, offering advantages including active patient cooperation and reduced systemic effects. However, some patients experience significant anxiety during awake regional anesthesia, and a minority may develop acute panic attacks. We report the case of a 52-year-old woman with no prior psychiatric history who underwent elective total knee replacement under spinal anesthesia. Approximately 35 minutes after successful spinal anesthesia, she developed acute symptoms including severe anxiety, palpitations, chest tightness, dyspnea, a feeling of impending doom, and uncontrollable trembling. Vital signs revealed tachycardia (142 bpm) and hypertension (180/95 mmHg), while oxygen saturation remained within normal limits. The surgical team considered aborting the procedure and converting to general anesthesia. Immediate bedside psychological intervention was provided by the attending anesthetist (with clinical psychology training), consisting of grounding techniques, breathing retraining, cognitive reassurance, and guided imagery. Symptoms resolved within eight minutes, and surgery proceeded uneventfully. This case highlights the importance of recognizing panic attacks in the intraoperative setting and demonstrates that brief psychological intervention can avert procedure abandonment and facilitate successful completion of surgery.
Joshua Nmezi (Tue,) conducted a case report in Acute panic attack during spinal anesthesia (n=1). Intraoperative psychological intervention (grounding, breathing retraining, cognitive reassurance, guided imagery) was evaluated on Resolution of panic symptoms and completion of surgery. Intraoperative psychological intervention successfully resolved an acute panic attack within eight minutes during spinal anesthesia, allowing surgery to proceed without conversion to general anesthesia.