A patient with a history of syncope experiencing cardiac arrest after brachial plexus block.

A patient with a history of syncope developed bradycardia and cardiac arrest following brachial plexus block and positioning in the beach chair position during shoulder arthroscopy.

• The patient was a 65-year-old male with a history of hypertension and diabetes
• The patient had a pre-existing history of syncope, identifying him as a high-risk individual
• Bradycardia developed after the patient was placed in the beach chair position
• Bradycardia progressed to cardiac arrest during the procedure

Prompt cardiopulmonary resuscitation successfully restored the patient's heart rate and consciousness following cardiac arrest.

• Cardiopulmonary resuscitation (CPR) was administered following the cardiac arrest
• The intervention restored both heart rate and consciousness
• The case highlights the importance of immediate resuscitative measures in the perioperative setting

Multiple mechanisms were identified as possible causes of the cardiac arrest, including vasovagal reflex, dexmedetomidine effects, and the Bezold-Jarisch reflex.

• The patient was sedated with dexmedetomidine, a drug known for its bradycardic and hypotensive effects
• The vasovagal reflex was identified as a contributing mechanism
• The Bezold-Jarisch reflex, which can cause bradycardia and hypotension, was implicated
• The beach chair position is known to predispose patients to hemodynamic instability through these reflex mechanisms

Recognizing high-risk individuals and implementing preventive strategies is proposed as crucial for avoiding similar events.

• A prior history of syncope was identified as a key risk factor for adverse hemodynamic events
• The report proposes preventive measures targeting known risk factors
• Identifying high-risk patients before brachial plexus block and beach chair positioning is emphasized
• The combination of sedation with dexmedetomidine, regional block, and beach chair positioning represents a compounding risk scenario