Severe bradycardia due to Bezold-Jarisch reflex occurred during arousal from dexmedetomidine under spinal and epidural anesthesia: Case report

DOI
  • Mizuta Yukie
    Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University
  • Daikaku Takafumi
    Department of Orthopedic Surgery, Oita Red Cross Hospital
  • Fujiyoshi Tetsuhiro
    Department of Anesthesiology, Kyushu Central Hospital
  • Matsushita Katsuyuki
    Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital
  • Shirozu Kazuhiro
    Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital
  • Higashi Midoriko
    Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University
  • Yamaura Ken
    Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University

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Description

 Severe bradycardia and hypotension during arousal from sedation with dexmedetomidine in a patient with combined spinal and epidural anesthesia is rare. We present a case of a 60-year-old woman who underwent total hip arthroplasty (THA) under combined spinal and epidural anesthesia (CSEA). Severe bradycardia (10 bpm) and hypotension were developed at arousal from sedation with dexmedetomidine prior to the end of the surgery. At that time, she complained of shoulder pain. Cardiac rhythm was restored by the administration of atropine. She was not under high spinal anesthesia. This severe bradycardia was mainly attributed to Bezold-Jarisch reflex (BJR) with decreased preload due to the low concentration of dexmedetomidine and increased inotropic state because of severe pain. BJR may develop during arousal from sedation with dexmedetomidine under combined spinal and epidural anesthesia.

Journal

  • CIRCULATION CONTROL

    CIRCULATION CONTROL 44 (2), 99-102, 2023

    Japan Society of Circulation Control in Medicine

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