Cardiac arrest due to a vagal reflex potentiated by thoracic epidural analgesia

J Int Med Res. 2006 Jul-Aug;34(4):433-6. doi: 10.1177/147323000603400414.


Reflex bradycardia and cardiac arrest may be the result of a vagal reflex, which can occur during a variety of surgical procedures. We report a patient who developed cardiac arrest as a result of a vagal reflex that was potentiated by thoracic epidural analgesia during general anaesthesia. A 53-year-old man was scheduled for subtotal gastrectomy because of an early gastric adenocarcinoma. After an epidural catheter had been inserted, general anaesthesia was induced. During surgery, an abdominal self-retaining retractor was set up but bradycardia and cardiac arrest developed. The patient returned to a normal sinus rhythm after successful resuscitation. We conclude that bradycardia as a result of a vagal reflex is mediated by potent abdominal wall traction and is potentiated by epidural analgesia. Early diagnosis and proper treatment can allow a full recovery, even in high-risk patients.

Publication types

  • Case Reports

MeSH terms

  • Abdomen / surgery*
  • Analgesia, Epidural / adverse effects*
  • Analgesia, Epidural / methods
  • Anesthetics, Local / adverse effects*
  • Baroreflex / drug effects*
  • Bradycardia / chemically induced
  • Bradycardia / physiopathology
  • Catheterization / adverse effects
  • Heart Arrest / chemically induced*
  • Heart Arrest / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Vagus Nerve / drug effects*
  • Vagus Nerve / physiopathology


  • Anesthetics, Local