Year : 2022  |  Volume : 16  |  Issue : 4  |  Page : 485-487

Differential diagnosis of intraoperative cardiac arrest after spine surgery in prone position

Anesthesiology Department of Hospital das Clínicas da Universidade Federal de Minas Gerais (Clinic's Hospital of the Federal University of Minas Gerais, Brazil), Brazil

Correspondence Address:
Davi Brasil Khouri
Rua Monte Alverne, 90, apt 401 – Floresta. Belo Horizonte - 31015-400, MG
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sja.sja_893_21

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Intraoperative cardiac arrest is one of the most feared events by anesthesiologists and surgeons. Although there are many possible causes, three differential diagnoses stand out in the presented scenario: pulmonary embolism, gas embolism, and acute myocardial infarction. A 61-year-old female patient was admitted in the hospital to C2-C5 arthrodesis. Despite no major bleeding during surgery, immediately after supination the patient developed refractory hypotension, a decrease in end tidal CO2, progressive bradycardia that ultimately led to pulseless electrical activity. Resuscitation maneuvers were promptly performed, sustained return of spontaneous circulation was attained after 50 minutes, and the patient was transferred to the ICU. This paper discusses the main causes for an episode of cardiac arrest in the context of cervical arthrodesis, with a markedly prolonged resuscitation time, in which the patient survived.

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