Asystolic cardiac arrest: an unusual reaction following iv metoclopramide

To describe a case of sinus arrest after iv metoclopramide.

A 66-yr-old diabetic female with no cardiovascular disease was anesthetized for a partial mastectomy. While in the postanesthesia care unit, she suffered two episodes of asystole after iv metoclopramide 10 mg. The first episode lasted ten seconds and corrected spontaneously while the second episode, lasting less than one minute required closed chest massage and atropine iv 0.8 mg. The cardiac investigation that followed was inconclusive for ischemia and the patient did not experience any other episodes of dysrhythmia. No formal investigation was done to disclose diabetic autonomic neuropathy. However, based on the results of dipyridamole myocardial single photon emission computed tomography, if diabetic autonomic neuropathy was present, it was very mild.

The patient sustained two episodes of asystole after iv metoclopramide 10 mg in the immediate postoperative period in the absence of any predisposing cardiac history or medication. Diabetes, even without overt autonomic neuropathy, may have been a predisposing factor for sinus arrest after iv metoclopramide.