Vasovagal Bradycardia During Subarachnoid Anaesthesia for Myomectomy.

Abstract

There is an increasing use of central neuraxial blocks for lower abdominal surgeries. Increased vagal tone under subarachnoid block is a well-known phenomenon and can have non-classical presentations. It can manifest with bradycardia, hypotension, bronchospasm, coronary artery spasm and cardiac arrest. In a patient with an additional underlying vagal predominance, disturbing intraoperative events such as peritoneal traction can complicate the situation, precipitating a vasovagal reaction of bradycardia and even cardiac arrest. We report a 30 year old Nigerian woman who had an elective myomectomy under subarachnoid anaesthesia. Intra operatively, she developed sudden bradycardia and cardiac arrest which were successfully managed. We propose that the bradycardia and cardiac arrest was secondary to a combination of the vasovagal effects of peritoneal traction in a patient with an increased vagal tone under spinal anaesthesia. We recommend prompt and effective management to ensure good outcome.

Keywords: Vasovagal, bradycardia, subarachnoid anaesthesia, complications, parasympathetic nervous system