ArticleJournal of spine surgery (Hong Kong)2025
Intraoperative bradycardia leading to cardiac arrest during anterior lumbar interbody fusion (ALIF) in a morbidly obese patient-a rare complication and management strategy: a case report.
Article in Journal of spine surgery (Hong Kong), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Intraoperative bradycardia leading to cardiac arrest is a rare and serious complication during anterior lumbar interbody fusion (ALIF) surgeries. This case report presents a unique and previously undocumented instance of bradycardia progressing to asystole during an ALIF, highlighting the importance of autonomic nervous system involvement and intraoperative vigilance. Case Description: A 64-year-old female with a history of hypertension and morbid obesity was scheduled for an ALIF at L5/S1 due to adjacent segment disease (ASD) and foraminal stenosis at that level. Intraoperatively, after manipulation of the peritoneum and blunt dissection around the aortic bifurcation, her heart rate (HR) suddenly dropped to 50 beats per minute (bpm), followed by a rapid decrease in blood pressure (BP) and cardiac arrest. Immediate cardiopulmonary resuscitation (CPR) and administration of ephedrine successfully restored spontaneous circulation within 30 seconds. The surgical and anesthesia teams promptly decided to abort the operation. Further evaluation revealed no evidence of myocardial infarction, and the patient made a full recovery. This rare event suggests that hyper vagal stimulation from manipulation of the superior hypogastric plexus (SHP) and peritoneum may be a possible mechanism. It underscores the critical importance of vigilant monitoring, prompt intervention, and effective communication between surgical and anesthesia teams to manage acute hemodynamic instability during high-risk spinal surgeries. Conclusions: This case illustrates a rare but critical intraoperative event likely caused by hyper vagal stimulation during anterior spinal exposure near autonomic plexuses. Surgeons and anesthesiologists must be aware of this potential complication. Prompt recognition and a coordinated team response are essential for favorable outcomes. Consideration of invasive hemodynamic monitoring and collaboration with access surgeons may improve safety in complex ALIF procedures, especially in high-risk patients such as those with morbid obesity.
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