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Asystole From Direct Laryngoscopy: A Case Report and Literature Review
Andrew J. Redmann MD,
 Gregory D. White DDS,
 Benu Makkad MD, and
 Rebecca Howell MD
Article Category: Case Report
Volume/Issue: Volume 63: Issue 4
Online Publication Date: Jan 01, 2016
DOI: 10.2344/16-00014.1
Page Range: 197 – 200

Direct laryngoscopy is routinely performed by both anesthesiologists and otolaryngologists and is commonly associated with dental injury, tongue paresthesia, and/or bleeding gums. However, despite its routine nature, more serious complications, such as airway injury, esophageal injury, or bradycardia due to the stimulation of the vagal reflex, can occur. 1 In extreme situations, it can present as asystole. Asystole, especially intraoperatively, is cardiogenic until proven otherwise. Described herein is a case of direct laryngoscopy

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Figure 3 ; Asystole at 2:20 pm captured on multiple monitoring devices with spontaneous return of pulse and normal sinus rhythm following laryngoscope removal. Repeat episode of asystole with loss of radial pulse too brief to be captured on documented operating room record at 2:22 pm upon second attempt with laryngoscope. Previously witnessed bradycardia and asystole counteracted on third attempt of laryngoscope placement (2:29 pm) with anticholinergic medication and deepening of anesthetic.
Andrew J. Redmann,
 Gregory D. White,
 Benu Makkad, and
 Rebecca Howell
<bold>Figure 3</bold>
Figure 3

Asystole at 2:20 pm captured on multiple monitoring devices with spontaneous return of pulse and normal sinus rhythm following laryngoscope removal. Repeat episode of asystole with loss of radial pulse too brief to be captured on documented operating room record at 2:22 pm upon second attempt with laryngoscope. Previously witnessed bradycardia and asystole counteracted on third attempt of laryngoscope placement (2:29 pm) with anticholinergic medication and deepening of anesthetic.

Case of Vasovagal Syncope With Asystole Associated With Propofol Sedation
Keiko Fujii-Abe DDS, PhD,
 Kazutaka Uriu DDS, and
 Hiroshi Kawahara DDS, PhD
Article Category: Case Report
Volume/Issue: Volume 62: Issue 4
Online Publication Date: Jan 01, 2015
DOI: 10.2344/13-00034.1
Page Range: 159 – 161

The vasovagal response can be triggered by stress, prolonged standing, extreme emotions, or severe pain. 1 It is caused by reduced arterial pressure and blood supply to the brain and is mediated through neural mechanisms rather than primary cardiac dysfunction. 2 Most modern anesthetic agents do not have anticholinergic or sympathomimetic side effects. Simple vasovagal reflexes with bradycardia and transient asystole are more common. 3 Bradycardic complications have been reported to occur after induction, during, or at the end of propofol

Figure 2.; Asystole (7.2 seconds in duration).
Keiko Fujii-Abe,
 Kazutaka Uriu, and
 Hiroshi Kawahara
Figure 2.
Figure 2.

Asystole (7.2 seconds in duration).

Cardiac Arrest Upon Induction of General Anesthesia
Regina A. E. Dowdy DDS,
 Shadee. T. Mansour DDS,
 James H. Cottle DDS,
 Hannah R. Mabe DDS,
 Harry B. Weprin DMD,
 Leigh E. Yarborough DMD,
 Gregory M. Ness DDS,
 Todd M. Jacobs DMD, and
 Bryant W. Cornelius DDS, MBA, MPH
Article Category: Case Report
Volume/Issue: Volume 68: Issue 1
Online Publication Date: Apr 07, 2021
DOI: 10.2344/anpr-67-03-08
Page Range: 38 – 44

, automated external defibrillator pads were applied, and a rhythm check was performed. However, the patient was in asystole, so no shock was warranted. There were no pulse oximetry or capnography waveforms present. Chest compressions immediately resumed, and an IV bolus of epinephrine (1 mg) was administered followed by a 10-mL saline flush. Oral intubation was attempted a second time by a different provider and was again unsuccessful likely because of ongoing chest compressions. A flexible size 5 laryngeal mask airway (LMA) was placed to facilitate asynchronous

Figure 1.; Electrocardiogram on 5th intravenous sedation. ECG showed asystole after failure of inserting the catheter into the vein. Spontaneous heart beats recovered to normal sinus rhythm after about 20 sec asystole.
Figure 1.
Figure 1.

Electrocardiogram on 5th intravenous sedation.

ECG showed asystole after failure of inserting the catheter into the vein. Spontaneous heart beats recovered to normal sinus rhythm after about 20 sec asystole.

Figure 19.; Ventricular fibrillation and asystole. Here we have the worst tracings of all. Tracing A is pure chaos with no consistent waves whatsoever—ventricular fibrillation. In tracing B, following a single beat, we have no further evidence of electrical activity. This is called asystole. In either case, the patient is in cardiac arrest with no pulse.
Daniel E. Becker
Figure 19.
Figure 19.

Ventricular fibrillation and asystole. Here we have the worst tracings of all. Tracing A is pure chaos with no consistent waves whatsoever—ventricular fibrillation. In tracing B, following a single beat, we have no further evidence of electrical activity. This is called asystole. In either case, the patient is in cardiac arrest with no pulse.

Figure 1 ; Preoperative stroboscopy findings of grade 3 stenosis of the subglottis.
Andrew J. Redmann,
 Gregory D. White,
 Benu Makkad, and
 Rebecca Howell
<bold>Figure 1</bold>
Figure 1

Preoperative stroboscopy findings of grade 3 stenosis of the subglottis.

Figure 2 ; Dedo laryngoscope.
Andrew J. Redmann,
 Gregory D. White,
 Benu Makkad, and
 Rebecca Howell
<bold>Figure 2</bold>
Figure 2

Dedo laryngoscope.

Figure 1.  ; Electrocardiogram with normal sinus rhythm.
Regina A. E. Dowdy,
 Shadee. T. Mansour,
 James H. Cottle,
 Hannah R. Mabe,
 Harry B. Weprin,
 Leigh E. Yarborough,
 Gregory M. Ness,
 Todd M. Jacobs, and
 Bryant W. Cornelius
<bold>Figure 1. </bold>
Figure 1. 

Electrocardiogram with normal sinus rhythm.