Cardiac arrest complicating routine throat pack insertion in oral and maxillofacial surgery under general anesthesia:...

Throat packs are routinely inserted during oral and maxillofacial surgery and are generally considered safe. However, severe vagally mediated cardiovascular reflexes can rarely occur during airway or oropharyngeal manipulation. The present study describes a rare case of cardiac arrest directly attributed to throat pack insertion. A healthy 54-year-old male patient underwent third molar extraction under general anesthesia. Immediately following throat pack placement, he developed sudden cardiac arrest with complete electrical asystole lasting ~20 sec. Spontaneous circulation returned rapidly following the intravenous administration of ephedrine (8 mg) without the need for chest compressions. This event was most consistent with a vagal reflex-mediated response. The present case report indicates that vigilant hemodynamic monitoring, adequate ventilation and appropriate anesthetic depth are essential even during routine adjunctive steps, such as throat pack insertion.