Abstract

Hypotension and bradycardia following conduction anesthesia is common, generally due to sympathetic blockade. Three cases of sudden profound cardiovascular depression during recovery from epidural anesthesia associated with marked distension of the urinary bladder are described. The suggested mechanisms include afferent atimulation from bladder distension and efferent reflex loss of peripheral resistance, decreased venous pressure, and bradycardia. The key to restoration of autonomic balance is bladder drainage. Adjunctive therapy should include augmentation of venous return by position change, and administration of anticholinergics, vasopressors, and fluids.