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[Transient second-degree A-V block during an epidural procedure].

A Handa1, K Yokoyama

  • 1Department of Anesthesiology, Daiichi Hospital, Nippon Medical School, Tokyo.

Masui. the Japanese Journal of Anesthesiology
|August 1, 1992
PubMed
Summary

A pregnant patient experienced bradycardia and heart block during epidural anesthesia placement. This event, likely due to periosteal pain, highlights the need for continuous ECG monitoring during neuraxial procedures.

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Area of Science:

  • Anesthesiology
  • Cardiology
  • Obstetrics

Background:

  • A 26-year-old pregnant female at 16 weeks gestation underwent scheduled surgery for a left ovarian tumor.
  • Spinal anesthesia and continuous epidural catheter placement for postoperative pain management were planned.

Observation:

  • During epidural needle insertion at L2-3, the patient developed recurrent bradycardia and hypotension (82/44 mmHg).
  • The electrocardiogram (ECG) revealed second-degree atrioventricular (AV) block (Wenckebach type) during the procedure.

Findings:

  • The bradycardia and AV block were attributed to vagal stimulation secondary to sharp periosteal pain from the Tuohy needle contacting the lamina arcus vertebrae.
  • The patient reported no discomfort despite the observed hemodynamic and cardiac rhythm changes.

Implications:

  • This case underscores the importance of continuous ECG monitoring during neuraxial anesthesia procedures.
  • Awareness of potential vagal-mediated arrhythmias, such as AV block, is crucial for preventing severe hemodynamic compromise in obstetric patients.

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