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

Area of Science:

• Anesthesiology
• Cardiology
• Oncology

Background:

• A 70-year-old male with no prior cardiac history underwent a hemicolectomy for colon cancer recurrence.
• General anesthesia was induced without immediate complications.

Purpose of the Study:

• To report a rare case of asystolic arrest during anesthesia.
• To investigate the potential synergistic effects of anesthetic agents and surgical manipulation on cardiac function.

Main Methods:

• Administration of dexmedetomidine infusion and bupivacaine epidural bolus prior to surgical incision.
• Continuous monitoring of vital signs during general anesthesia for hemicolectomy.
• Immediate cardiopulmonary resuscitation (CPR) initiated upon asystolic arrest.

Main Results:

• The patient developed acute bradycardia progressing to asystolic arrest 20 minutes after surgical incision.
• Return of circulation was achieved after three minutes of CPR.
• The surgical procedure was aborted, and the patient recovered fully.

Conclusions:

• Dexmedetomidine and bupivacaine may have synergistically exacerbated an underlying predisposition to bradycardia.
• Surgical manipulation likely increased vagal tone, contributing to the asystolic event.
• This case underscores the importance of a thorough preoperative cardiac evaluation, especially in patients with a history of syncope or unexplained bradycardia.