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[Pulseless electric activity during postural change after epidural anesthesia].

Jun Ariyama¹, Yoshiko Toyama, Yuji Sugimoto

¹Division of Anesthesia, Tonami General Hospital, Tonami, Japan.

Masui. the Japanese Journal of Anesthesiology

|February 19, 2008

Summary

A patient experienced pulseless electrical activity (PEA) after epidural anesthesia during a posture change. This rare event, linked to anesthesia and diabetic autonomic neuropathy, was successfully managed with therapeutic hypothermia.

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Area of Science:

Anesthesiology
Cardiology
Neurology

Background:

A 79-year-old male with poorly controlled diabetes underwent surgery for a left femoral neck fracture.
Epidural anesthesia was administered at the L3-4 level in the right lateral position.

Observation:

Shortly after repositioning to supine, the patient lost consciousness with unmeasurable blood pressure.
Electrocardiogram (ECG) revealed sinus rhythm, leading to a diagnosis of pulseless electrical activity (PEA).

Findings:

The patient's loss of consciousness persisted despite blood pressure restoration with epinephrine.
Therapeutic hypothermia (34°C for 48 hours) was initiated following the PEA event.
No neurological deficits were observed after the patient recovered from therapeutic hypothermia.

Implications:

The case suggests a potential link between epidural anesthesia-induced hypotension and diabetic autonomic neuropathy in precipitating PEA.
This highlights the importance of vigilant monitoring during anesthetic procedures in patients with complex comorbidities.
Therapeutic hypothermia may be a beneficial intervention for neurological protection following such critical events.