Vasovagal Syncope during a Caudal Epidural Block in a Patient with Vertebral Fractures: A case report / 대한마취과학회지

Age-related vertebral fractures occur frequently in the elderly recently. An epidural block has been introduced as an effective management for the treatment of pain with vertebral compression fractures. While an epidural block is considered to be reasonably safe, serious complications may occur even when this invasive procedure is related to pain. Vasovagally mediated episodes of hypotension and bradycardia are thought to be a common cause of recurrent unexplained syncope. Precipitating factors include pain, trauma, fatigue, blood loss, or prolonged motionless standing. We report one case of vasovagal syncope associated with severe bradycardia and hypotension in a 78 year-old male patient with vertebral fractures. Syncopal attacks occurred during a caudal epidural block. The patient was resuscitated successfully and recovered without any adverse effects.

Severe Bradycardia and Hypotension during Spinal Anesthesia in a Patient with Agent Orange Sequela: A case report / 대한마취과학회지

Various defoliant herbicides were sprayed to kill vegetation and thereby denied cover to enemy forces in Vietnam war, and the defoliant was later alleged to have caused long-lasting health problems such as cancers, birth defects, skin disorders, hepatic dysfunction, porphyria, peripheral neuropathy, and impaired immune function. We experienced a case of severe bradycardia and hypotension during spinal anesthesia for diagnostic arthroscopy in a 53-year-old Vietnam veteran with peripheral neuropathy. We concluded that it should require constant monitoring and vigilance to prevent severe cardiovascular complications during spinal anesthesia in Agent Orange sequela patients with peripheral neuropathy.