Asystole From Direct Laryngoscopy: A Case Report and Literature Review
The rare and potentially fatal complication of asystole during direct laryngoscopy is linked to direct vagal stimulation. This case describes asystole in an 85-year-old female who underwent suspension microlaryngoscopy with tracheal dilation for subglottic stenosis. Quick recognition of this rare event with immediate cessation of laryngoscopy resulted in the return of normal sinus rhythm. This incident emphasizes the implications of continued vigilance during laryngoscopy and the importance of communication between the anesthesia and surgical staff to identify and treat this rare complication. The case was successfully concluded by premedication with an anticholinergic and by increasing the depth of anesthesia.
Preoperative stroboscopy findings of grade 3 stenosis of the subglottis.
Dedo laryngoscope.
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.
Contributor Notes