Kirsch Colin, Badwal Areen, Rabany Romain, Shabanian Julia, Dormer Carla L
Anesthesiology, Creighton University School of Medicine, Phoenix, USA.
Psychiatry, Creighton University School of Medicine, Phoenix, USA.
Cureus. 2024 Feb 5;16(2):e53643. doi: 10.7759/cureus.53643. eCollection 2024 Feb.
The Bezold-Jarisch reflex (BJR) is an inhibitory reflex characterized by bradycardia, hypotension, and apnea originating from ventricular mechanoreceptors. BJR is an uncommon but serious complication of neuraxial anesthesia. We present a case of a 33-year-old female undergoing combined spinal-epidural anesthesia prior to cesarean delivery who developed profound BJR, resulting in emergent actions. Within minutes of injection, she became severely bradycardic (HR: 17 bpm) and hypotensive (SBP: 30s mmHg) with bradypnea (RR: 6/min) and was treated with epinephrine. Fetal bradycardia prompted emergency cesarean section. Following delivery, the patient developed ventricular tachycardia, which was treated with intravenous fluids and cardiac monitoring. Both patient and neonate were discharged in stable condition on postoperative day four. This case illustrates the rapid maternal and fetal compromise associated with BJR during neuraxial anesthesia and the need for prompt recognition and treatment. Key steps include stopping anesthesia, intravenous fluid, left-lateral positioning, judicious vasopressors, fetal monitoring, and preparing for emergent delivery.
贝佐尔德-雅里什反射（BJR）是一种抑制性反射，其特征为源自心室机械感受器的心动过缓、低血压和呼吸暂停。BJR是神经轴索麻醉一种罕见但严重的并发症。我们报告一例33岁女性，在剖宫产术前接受腰麻-硬膜外联合麻醉时发生严重的BJR，从而采取了紧急措施。注射后几分钟内，她出现严重心动过缓（心率：17次/分钟）、低血压（收缩压：30多岁毫米汞柱）伴呼吸过缓（呼吸频率：6次/分钟），并接受了肾上腺素治疗。胎儿心动过缓促使进行紧急剖宫产。分娩后，患者出现室性心动过速，通过静脉输液和心脏监测进行治疗。患者和新生儿均在术后第4天病情稳定出院。该病例说明了神经轴索麻醉期间与BJR相关的母婴迅速出现的不良情况，以及迅速识别和治疗的必要性。关键步骤包括停止麻醉、静脉输液、左侧卧位、谨慎使用血管升压药、胎儿监测以及为紧急分娩做好准备。
