A case of cardiac arrest during insertion of an epidural needle and before the administration of any epidural medication

Cardiac arrest following regional anesthesia is a relatively common and often a grave complication. A number of cases have been reported in literary sciences. Here, we report a case of 28-year-old young adult female posted for femur nailing surgery who sustained a cardiac arrest on insertion of epidural needle even before epidural catheter could be secured or any epidural medication was administered. Fortunately, she was successfully resuscitated with timely and appropriate cardiopulmonary resuscitative efforts. Here, we consider excess vagal activity associated with excess anxiety to be the probable cause of syncope and hypoxia leading to tachyarrhythmia and finally culminating to cardiac arrest. The present case report would probably allow us to explore the possible causes of such an unusual and possibly an avoidable event. Careful preoperative assessment of patient anxiety level, reassurance, good sedative premedication, alternate positioning for regional technique, and finally close monitoring and prompt intervention would definitely improve outcomes.