Acute Panic Attack During Spinal Anesthesia: Successful Management With Intraoperative Psychological Intervention

Spinal anesthesia is widely used for lower abdominal and orthopedic procedures, offering advantages including active patient cooperation and reduced systemic effects. However, some patients experience significant anxiety during awake regional anesthesia, and a minority may develop acute panic attacks. We report the case of a 52-year-old woman with no prior psychiatric history who underwent elective total knee replacement under spinal anesthesia. Approximately 35 minutes after successful spinal anesthesia, she developed acute symptoms including severe anxiety, palpitations, chest tightness, dyspnea, a feeling of impending doom, and uncontrollable trembling. Vital signs revealed tachycardia (142 bpm) and hypertension (180/95 mmHg), while oxygen saturation remained within normal limits. The surgical team considered aborting the procedure and converting to general anesthesia. Immediate bedside psychological intervention was provided by the attending anesthetist (with clinical psychology training), consisting of grounding techniques, breathing retraining, cognitive reassurance, and guided imagery. Symptoms resolved within eight minutes, and surgery proceeded uneventfully. This case highlights the importance of recognizing panic attacks in the intraoperative setting and demonstrates that brief psychological intervention can avert procedure abandonment and facilitate successful completion of surgery.