[Case of profound bradycardia and cardiac arrest during left upper lobectomy and lymph node dissection]

We present a case of profound bradycardia and cardiac arrest in a 61-year-old man, which occurred during left upper lobectomy and lymph node dissection for the ligamentum arteriosum. General anesthesia was maintained by propofol TIVA combined with epidural anesthesia. During the electrocautery dissection of the lymph node of the ligamentum arteriosum the patient became extremely bradycardic for 10 min. Subsequent traction with forceps further aggravated the bradycardia leading to cardiac arrest. In order to continue the procedure, we initiated epicardial pacing and switched to isoflurane anesthesia. Given the close proximity of the lymph node of the ligamentum arteriosum to the thoracic cardiac branch of the vagus nerve and the cardiac plexus, we believe that the observed bradycardia and cardiac arrest are likely attributable to vasovagal stimulation.