A case is reported of a healthy patient who developed a paroxysmal atrio-ventricular heart block followed by unconsciousness and respiratory arrest 35 minutes after the induction of spinal anesthesia. A second heart block occurred with milder symptoms at the end of surgery, 80 minutes after induction. This complication, which promptly responded to intravenous atropine, is tentatively attributed to a vagal reflex elicited by a sudden decrease in venous return to the heart. In fact, the heart block developed concomitant to a moderate but brisk hemorrhage and to a postural change. The clinical implications of this case are briefly discussed.
- Spinal anesthetic
- heart block
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