PMC9829882_01
(a) II-lead ECG findings revealing the change from sinus bradycardia to transient asystole associated with VVR followed by recovery to sinus rhythm via AVJR. (b) II-lead ECG during IVS management after recovering to normal sinus rhythm (blood pressure: 109/63 mmHg, heart rate: 83 bpm). The ECGs in (a) and (b) were taken by the same II-lead device.. Oxygenation and intravenous fluid loading in the supine position with elevation of the lower extremities successfully restored sinus rhythm and normal hemodynamics without the intervention of cardiopulmonary resuscitation including administration of intravenous atropine and adrenaline, chest compressions, and defibrillation.
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Immediately afterwards, she complained of some discomfort and nausea, and then the ECG showed the change from serious bradycardia below 30 bpm to transient asystole for 18 s associated with VVR (Figure 1(a)), followed by a loss of consciousness for several seconds. Prompt oxygenation, intravenous fluid loading by lactated Ringer's solution, and relaxation in the supine position with elevation of the lower extremities without the intervention of cardiopulmonary resuscitation successfully restored sinus rhythm via atrioventricular junctional rhythm (AVJR) (Figure 1(a)) (blood pressure: 111/67 mmHg, heart rate: 75 bpm). Her blood pressure (90-110/58-75 mmHg), heart rate (65-85 bpm), electrocardiographic finding (normal sinus rhythm), and oxygen saturation (99%-100%) were stable throughout the stress-free management of IVS (Figure 1(b)).
Perioperative management record.. The patient experienced a transient asystole associated with VVR immediately after peripheral intravenous catheterization for IVS. After restoration of normal sinus rhythm, the patient was uneventfully treated with optimal sedation under premedication of atropine and betamethasone with no signs of cardiovascular and respiratory disorders.
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Recovery from sedation after administration of flumazenil 0.5 mg was satisfactory without re-sedation (Figure 2).