[Pulseless electric activity during postural change after epidural anesthesia]

We experienced a case of pulseless electrical activity (PEA) during posture change after epidural anesthesia. A 79-year-old man was scheduled for open reduction of left femoral neck fracture. Past history included severe diabetes, which is hardly controlled even by hypodermic injection of insulin before surgery. We performed epidural anesthesia at L3-4 level in right lateral position. Shortly after turning the patient to supine position, the patient became unconscious and blood pressure was unmeasurable. ECG showed sinus rhythm and he was diagnosed as PEA. Loss of consciousness was prolonged even after recovery of blood pressure by intravenous injection of epinephrine 1 mg. The patient underwent therapeutic hypothermia (target temperature 34 degrees C) over a period of 48 hours. The patient showed no neurological dysfunction after recovery from therapeutic hypothermia. We consider that the cause of PEA is blood pressure decrease associated with epidural anesthesia and diabetic autonomic neuropathy.