Vasovagal Syncope during Epidural Catheterization before Administration of Local Anaesthetics

Abstract

Triggers and differential diagnosis for vasovagal response are numerous, possible differentials are important in making its diagnosis. This is usually made from a good history with a high index of suspicion in the presence of the risk factors and with a good understanding of the pathophysiology. The risk factors can be patient related (young, athletics, hypertensive, history of syncope, inferior myocardial infarction and others), anaesthesia related (light anaesthesia, spinal, epidural anaesthesia, airway manipulation, hypercapnia, hypoxia and others) and surgical related (strabismus, anal dilatation, abdominal and neurosurgery). In many instances there are many cofounders especially if anaesthesia has been administered. We present a case of vasovagal response in a healthy young male patient scheduled for excision of extra digits in both feet after catheterization of the epidural space but before administration of epidural medications. The uniqueness of this case is the changes in haemodynamic hypotension, bradycardia and syncope in an apparently healthy patient that could have occurred in the best of hands. Attention should therefore be paid to diagnosis and treatment as it runs a benign course.