Vagal Stimulation Causing Intra-operative Cardiac Arrest, A Major Dilemma Whether to Proceed or to Defer Surgery: A Case Report

Abstract

Vagal stimulation under general anesthesia can lead to life-threatening bradycardia and cardiac arrest. Here we present two cases of cervical carcinoma and tongue carcinoma, developing intra-operative cardiac arrest due to severe vagal stimulation, treated and resuscitated as per Advanced Cardiac Life Support protocol followed by clinical evaluation along with 12 lead electrocardiogram, arterial blood gases and screening echocardiogram, and completion of surgery. Also, we stress that intra-operative cardiac arrest is a dreadful consequence of severe vagal bradycardia leading to asystole, which needs to be recognized early and treated promptly followed by thorough clinical assessment and a decision regarding whether to proceed or abandon the surgery. This kind of cardiac arrest due to severe vagal stimulation which is resuscitated with minimal intervention may not call for deferring the surgical procedure if the evaluation done clinically together with tools of electrocardiogram, arterial blood gases, and screening echocardiogram are within the normal range.