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이광호,임현교,유영수 대한마취통증의학회 2005 Korean Journal of Anesthesiology Vol.49 No.4
Severe bradycardia and asystole are uncommon complications during epidural anesthesia but can be life threatening if not properly managed. There are several risk factors including baseline bradycardia, first degree AV block, preoperative beta-blocker, male gender, high sensory block level, and American Society of Anesthesiologists (ASA) physical status class 1. A 48-year-old, ASA class 1, male patient was admitted for the repair of a ventral hernia under epidural anesthesia. Approximately 60 minutes after the epidural anesthesia, heart rate decreased markedly to 10/min without loss of consciousness and a decrease in saturation. The heart rate returned to 90/min after administering atropine. We concluded that severe bradycardia was induced by vagal activation as a result of the low venous return and high sympathetic blockade (T4 sympathetic level).