Paroxysmal atrioventricular block in a healthy patient receiving spinal anesthesia: a case report

The presentation of type 1, second-degree atrioventricular block (AVB) in a young, healthy patient is rare. This article describes such an event in a 36-year-old white male under subarachnoid block (SAB) anesthesia. At 25 minutes into surgery, the pulse oximeter and the ECG monitor both alarmed for nonsensing and asystole, respectively. The patient had experienced a complete AVB. "Cough cardiopulmonary resuscitation (CPR)" was begun, and the patient was instructed to take deep breaths and cough as hard as possible. During the entire duration of the AVB, the patient never lost consciousness and continued cough CPR, with encouragement from the author. Ephedrine 12.5 mg in two doses was administered through the rapidly infusing intravenous line. The patient was continued on oxygen, as described, and the pulse oximeter continued to demonstrate a saturation greater than 96% during the entire event. After approximately 40 seconds, the patient's rhythm changed to a type 1, second-degree AVB. After an additional 15 minutes, the patient's sinus rhythm returned to normal. This event emphasizes the value of vigilance. Continuous monitoring, including pulse oximetry, blood pressure measurements, and continuous ECG, should be used on all patients receiving any form of anesthesia.