Arrest Under Anesthesia - What was the Culprit? A Case Report

Our case describes a 70 year-old male patient with no significant cardiac history who presented for a hemicolectomy for recurrence of colon cancer. Induction of general anesthesia was uneventful. A dexmedetomidine infusion was started prior to incision and a bolus of bupivacaine was administered via an indwelling epidural catheter. Twenty minutes after surgical incision, the patient acutely developed bradycardia that progressed to asystolic arrest. CPR was immediately initiated with return of circulation after three minutes. The case was aborted and the patient made a full recovery. The patient was evaluated by cardiology postoperatively. A detailed evaluation uncovered additional pertinent history of a syncopal event 1.5 years ago, and an episode of hypotension and bradycardia more recently that was not further investigated. In this case, dexmedetomidine and bupivacaine likely functioned synergistically to exacerbate an underlying propensity for bradycardia and increased vagal tone from surgical manipulation that culminated in asystole under anesthesia.