A CASE OF ASYSTOLE CAUSED BY LARYNGEAL STIMULATION DURING LARYNGOMICROSURGERY

Abstract

A 48-year-old woman presented to our ENT department with a history of feeling something wrong with her throat and hoarseness. Endoscopic examination revealed vocal cord polyp and oropharyngeal papilloma, and we decided to perform laryngomicrosurgery. The anesthesiologist used propofol and remifentanil during the induction and we achieved direct laryngoscopic exposure. The patient developed severe bradycardia, which led us to administer atropine. Shortly thereafter, the patient went into asystole. We immediately removed the laryngoscope and performed chest compressions. After 30 seconds, she regained spontaneous circulation and sinus rhythm. We believe the phenomenon was caused by vagal reflex with direct stimulation of the larynx. Therefore, the patient underwent temporary pacemaker insertion prior to the second surgery. She again developed bradycardia during the reoperation but recovered after the quick administration of atropine. The operation was then completed with no further events.

Anesthesia with the combination of propofol and remifentanil is known to cause parasympathetic dominance, and laryngeal expansion is a procedure that can stimulate a vagal reflex. Vital signs should be monitored in collaboration with the anesthesiologist during laryngomicrosurgery, as the appearance of bradycardia requires a prompt response with atropine.