Needle phobia and malignant vasovagal syndrome.

A case is reported in which suspicion of malignant vasovagal syndrome was aroused by a history of faints and needle phobia. The vasovagal response was successfully avoided using a gaseous induction of anaesthesia with sevoflurane. Intravenous access was achieved under general anaesthesia. The diagnosis of malignant vasovagal syndrome was confirmed postoperatively using a head-up tilt table test. An outline of the pathophysiology of the syndrome gives some indication for suitable anaesthetic management strategies in similar cases.