Pulseless electric activity during postural change after epidural anesthesia

We experienced a case of pulseless electrical activity (PEA) during posture change after epidural anesthesia. A 79-year-old man was scheduled for open reduction of left femoral neck fracture. Past history included severe diabetes, which is hardly controlled even by hypodermic injection of insulin be...

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Bibliographic Details
Published inMasui. The Japanese journal of anesthesiology Vol. 57; no. 2; p. 209
Main Authors Ariyama, Jun, Toyama, Yoshiko, Sugimoto, Yuji, Imanishi, Toshikazu, Shibata, Keizo
Format Journal Article
LanguageJapanese
Published Japan 01.02.2008
Subjects
Aged
Anesthesia, Epidural - adverse effects
Autonomic Nervous System Diseases - complications
Diabetic Neuropathies - complications
Electrocardiography
Femoral Neck Fractures - surgery
Humans
Hypotension, Orthostatic - etiology
Hypothermia, Induced
Male
Posture - physiology
Pulse
Unconsciousness - etiology
Unconsciousness - physiopathology
Unconsciousness - therapy
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Summary:We experienced a case of pulseless electrical activity (PEA) during posture change after epidural anesthesia. A 79-year-old man was scheduled for open reduction of left femoral neck fracture. Past history included severe diabetes, which is hardly controlled even by hypodermic injection of insulin before surgery. We performed epidural anesthesia at L3-4 level in right lateral position. Shortly after turning the patient to supine position, the patient became unconscious and blood pressure was unmeasurable. ECG showed sinus rhythm and he was diagnosed as PEA. Loss of consciousness was prolonged even after recovery of blood pressure by intravenous injection of epinephrine 1 mg. The patient underwent therapeutic hypothermia (target temperature 34 degrees C) over a period of 48 hours. The patient showed no neurological dysfunction after recovery from therapeutic hypothermia. We consider that the cause of PEA is blood pressure decrease associated with epidural anesthesia and diabetic autonomic neuropathy.
ISSN:0021-4892