Syncope and Bezold-Jarisch reflex in a dehydrated patient with spinal anesthesia for hernioplasty. Case report

Abstract

Introduction: Spinal anesthesia is one of the most used techniques in abdominal and lower extremity surgical procedures. The unintentional presentation of intrinsic cardiac reflexes can trigger bradycardia and hypotension, which if not corrected in time can cause cardiac arrest because of the sympathetic blockade derived from spinal anesthesia. There are also other factors that can precipitate such a scenario; for example: volume depletion and risk factors that may go unnoticed in some patients. Clinical case: We present the case of a 31-year-old patient diagnosed with left inguino-scrotal hernia. Body mass index (BMI) of 29.05 kg/m2, prolonged fasting (approximately 18 hours). In the operating room with stable vital signs, while sitting under monitoring, he presented an episode of syncope that immediately and spontaneously ceased with the right lateral decubitus; therefore, it was decided to continue with the anesthetic plan in this position. Bradycardia and severe hypotension occurred 10 minutes after the anesthetic block in the supine position. Diagnosis, interventions, and results: In this scenario of hemodynamic decompensation, atropine was administered, and a norepinephrine infusion was started, achieving restoration of the objectives for both heart rate and mean arterial pressure and patient comfort. Conclusion: The analysis of the possible risk factors in this patient, which led to a certainly dangerous outcome, favored the team to be prepared and to conduct an appropriate intervention to anticipate greater complications that were more difficult to control.