Key result
Intramedullary reaming in knee arthroplasty triggers reversible asystole via suspected vasovagal reflex.
Why the study?
Unexpected cardiac arrest during surgery is associated with high mortality and its causes are often multifactorial and unclear.
Case Report (n=1)
No
Highlights the need to identify patients at high risk for asystole due to vasovagal reflex or pain during surgery to prevent perioperative cardiac arrest.
BACKGROUND: Unexpected cardiac arrest in patients during surgery is associated with high mortality. Reasons are often multifactorial and unclear. CASE PRESENTATION: This case report describes a patient who developed reversible asystole during knee surgery under general anaesthesia. All diagnostic cardiac examinations were unremarkable. After surgery, the patient showed no further symptoms. CONCLUSION: To prevent cardiac arrest due to non-cardiac reasons, patients with a high risk for asystole caused by vasovagal reflex or by pain need to be identified. Preoperative conditions such as hypovolemia need to be improved prior to surgery, and additional monitoring should be used. Further investigations to determine the influence of non-cardiac disease and long-term medication are necessary.
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Burgdorff et al. (2019) conducted a case report in Asystole during total knee arthroplasty (n=1). Surgical manipulation of the medullary cavity during total knee arthroplasty was evaluated on Intraoperative asystole events. A 71-year-old female patient developed multiple reversible asystole events during intramedullary reaming and tibial component removal in total knee arthroplasty, likely triggered by a vasovagal reflex.
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