Key result
Atropine prevents bone manipulation-induced vasovagal asystole during knee surgery.
Why the study?
Unexpected cardiac arrest during surgery is associated with high mortality and often has multifactorial and unclear causes.
Case Report (n=1)
No
Highlights the risk of unexpected cardiac arrest due to non-cardiac reasons such as vasovagal reflex or pain during orthopedic surgery.
May signal non-cardiac triggers like vasovagal reflex in orthopedic procedures; leaves open need for prospective studies on perioperative monitoring.
Background: Unexpected cardiac arrest in patients during surgery is associated with high mortality. Reasons are often multifactorial and not exactly clear. Case presentation: Therefore, this case report describes a patient, who developed reversible asystole during knee surgery under general anesthesia. 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 high risk for asystole caused by vasovagal reflex or pain need to be identified. Preoperative conditions like hypovolemia need to be improved and additional monitoring should be used. Further investigations to find 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 Cardiac arrest during orthopedic surgery (n=1). Surgical manipulation of the medullary cavity was evaluated on Cardiac arrest / asystole. A 71-year-old female developed reversible asystole during knee surgery, likely due to a vasovagal reflex triggered by bone manipulation, which was prevented in a subsequent surgery with atropine.
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