Postoperative vasovagal cardiac arrest after spinal anesthesia for lumbar spine surgery

Background: Spinal anesthesia is being increasingly recognized as a favorable alternative to general anesthesia. However, there are still several considerations for its safe and effective use.

Case description: A 62-year-old male received spinal anesthesia during an uneventful L3-L5 decompressive laminectomy. However, he subsequently experienced a brief episode of pulseless electrical activity in the post-anesthesia care unit, and was successfully resuscitated without further sequelae. This was attributed to a vasovagal episode, with his notable prior history of experiencing vasovagal syncope with lightheadedness and fainting at the sight of blood.

Conclusion: Patients with a history of vasovagal syncope may be predisposed to experiencing brief potentiated episodes of severe bradycardia and even cardiac arrest following spinal anesthesia.