Bradycardia and hypotension necessitating CPR in a healthy adolescent following injection of a local anesthetic into the nasal septum: A case report, review of the literature and suggested immediate management

Abstract

General and local anesthetics are generally well tolerated in the healthy population. Complications may arise affecting the surgical and anesthetic course. We present a case of severe bradycardia and hypotension, along with ST depressions which developed following general anesthesia and local injection of lidocaine with epinephrine to the nose in a healthy male during routine otolaryngological surgery. Symptoms improved with atropine, epinephrine and chest compressions. Subsequent electrocardiogram and Troponin were abnormal, and normalized within days. Reviewing the literature, several possible etiologies arise. These include the Trigeminocardiac Reflex, Takotsubo cardiomyopathy and others. These are discussed and the condition's immediate management recommended.

Keywords

• Bradycardia
• Lidocaine
• Takotsubo
• Sinus
• Local