Cardiac Arrest After Interscalene Block Before Arthroscopic Shoulder Surgery: A Case Report

A 42-year-old previously healthy woman developed profound hypotension, bradycardia, and asystolic cardiac arrest requiring cardiopulmonary resuscitation after an interscalene block before being placed in the beach-chair position for shoulder arthroscopy.

Activation of the Bezold-Jarisch reflex, a vagally mediated reflex leading to hypotensive bradycardic episodes, is a rare but devastating complication of shoulder arthroscopy when performed with the combination of interscalene blocks and the beach-chair position. Our case shows that the Bezold-Jarisch reflex may occur in patients before placement in the beach-chair position and may even lead to extreme reactions in healthy patients including asystolic cardiac arrest.