Sudden bradycardia and asystole in an obese patient after spinal anaesthesia: successful resuscitation with inadvertent "pacing thumps.".

A 45-year old morbidly obese man with diabetes and severe chest problem had sudden bradycardia and sinus arrest in the Recovery Ward after an uneventful spinal anaesthesia. He responded promptly to "attempts" at external cardiac message with each thump producing a QTS complex until Atropine could be given to restore sinus rhythm. The possible causes of the episode and the usefulness of pacing thumps are discussed. Some implications for developing countries who are encouraging spinal anaesthesia are also discussed.