Ewha Med J.  2014 Dec;37(Suppl):S28-S32. 10.12771/emj.2014.37.S.S28.

Anesthetic Management for Lung Adenocarcinoma Experienced Acute Neurocardiogenic Syncope and Cardiac Arrest

• Han JH
• Kim YJ
• Kim JH
• Kim DY
• Lee GY
• Kim CH

• KMID: 2171308
• DOI: http://doi.org/10.12771/emj.2014.37.S.S28

Abstract

Vasovagal syncope is one of the most common causes of transient syncope during anesthesia for elective surgery in patients with a history of syncope and requires special attention and management of anesthetics. The causes and pathophysiological mechanism of this condition are poorly understood, but it has a benign clinical course and recovers spontaneously. However, in some cases, this condition may cause cardiovascular collapse resulting in major ischemic organ injury and be life threatening. Herein we report a case and review literature, regarding completing anesthesia safely during an elective surgery of a 59-year-old female patient with history of loss of consciousness due to suspected vasovagal syncope followed by cardiovascular collapse and cardiac arrest, which required cardiopulmonary resuscitation and insertion of a temporary pacemaker and intra-aortic balloon pump immediately after a fine-needle aspiration biopsy of a lung nodule located in the right middle lobe.

Keyword

Anesthesia; Lung neoplasms; Syncope, vasovagal

MeSH Terms

Adenocarcinoma*
Anesthesia
Anesthetics
Biopsy, Fine-Needle
Cardiopulmonary Resuscitation
Female
Heart Arrest*
Humans
Lung Neoplasms
Lung*
Middle Aged
Syncope
Syncope, Vasovagal*
Unconsciousness
Anesthetics

Figure

• 

  Fig. 1 Simple chest X-ray. It shows a mass (about 2.8×1.5 cm) in the right middle lobe (arrow) suggesting malignancy.

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  Fig. 2 Electrocardiography. (A) Electrocardiography before attack shows normal sinus rhythm (86 beats per minute [bpm]). (B) Electrocardiography immediately after cardiopulmonary resuscitation for cardiac arrest resulting from fatal vasovagal syncope shows wide QRS tachycardia (124 bpm), right bundle branch block (RBBB), and ST elevation. (C) Acute myocardial infarction was suspected with junctional rhythm (49 bpm) and ST elevation. (D) Preoperative electrocardiography showed normal sinus rhythm (76 bpm) 5 weeks after fatal vasovagal syncope.

Reference

1. Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al. Incidence and prognosis of syncope. N Engl J Med. 2002; 347:878–885.

2. White CM, Tsikouris JP. A review of pathophysiology and therapy of patients with vasovagal syncope. Pharmacotherapy. 2000; 20:158–165.

3. Chen-Scarabelli C, Scarabelli TM. Neurocardiogenic syncope. BMJ. 2004; 329:336–341.

4. Kinsella SM, Tuckey JP. Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex. Br J Anaesth. 2001; 86:859–868.

5. Jang YE, Do SH, Song IA. Vasovagal cardiac arrest during spinal anesthesia for Cesarean section: a case report. Korean J Anesthesiol. 2013; 64:77–81.

6. Park SY, Kim SS. An anesthetic experience with cesarean section in a patient with vasovagal syncope: a case report. Korean J Anesthesiol. 2010; 59:130–134.

7. Tsai PS, Chen CP, Tsai MS. Perioperative vasovagal syncope with focus on obstetric anesthesia. Taiwan J Obstet Gynecol. 2006; 45:208–214.

8. Shimizu K, Yoshii Y, Watanabe S, Hosoda C, Takagi M, Tominaga T, et al. Neurally mediated syncope associated with small cell lung cancer: a case report and review. Intern Med. 2011; 50:2367–2369.

9. Angelini P, Holoye PY. Neurocardiogenic syncope and Prinzmetal's angina associated with bronchogenic carcinoma. Chest. 1997; 111:819–822.

10. Koga T, Kaseda S, Miyazaki N, Kawazoe N, Abe I, Sadoshima S, et al. Neurally mediated syncope induced by lung cancer--a case report. Angiology. 2000; 51:263–267.

11. Gracie J, Baker C, Freeston MH, Newton JL. The role of psychological factors in the aetiology and treatment of vasovagal syncope. Indian Pacing Electrophysiol J. 2004; 4:79–84.

12. Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation. 2005; 111:2997–3006.

13. Parry SW, Matthews IG. Update on the role of pacemaker therapy in vasovagal syncope and carotid sinus syndrome. Prog Cardiovasc Dis. 2013; 55:434–442.