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LETTERS TO EDITOR
Year : 2020  |  Volume : 14  |  Issue : 2  |  Page : 278

Re: Recurrent asystole during laryngoscopy – A nightmare for the anesthesiologists


Department of Anesthesiology and Critical Care, Military Hospital Mohammed V, Rabat, Morocco

Correspondence Address:
Dr. Abdelghafour Elkoundi
Department of Anesthesiology and Critical Care, Military Hospital Mohammed V, FAR Avenue, Rabat - 10045
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_71_20

Rights and Permissions
Date of Submission22-Jan-2020
Date of Acceptance27-Jan-2020
Date of Web Publication5-Mar-2020
 


How to cite this article:
Elkoundi A, Meskine A, Samali M, Bensghir M. Re: Recurrent asystole during laryngoscopy – A nightmare for the anesthesiologists. Saudi J Anaesth 2020;14:278

How to cite this URL:
Elkoundi A, Meskine A, Samali M, Bensghir M. Re: Recurrent asystole during laryngoscopy – A nightmare for the anesthesiologists. Saudi J Anaesth [serial online] 2020 [cited 2020 Mar 30];14:278. Available from: http://www.saudija.org/text.asp?2020/14/2/278/280092



To the editor,

We read the paper written by Dr. Vinayagam et al.[1] with great interest. The authors should be commended for attempting to answer the question of why their patient presented recurrent asystole during laryngoscopy. According to the authors, the main causes were attributed to the exaggerated vagal reflexes during laryngoscopy in a hypertensive patient or the effect of raised bilirubin-associated obstructive jaundice on the sinoatrial node.

We would like to draw attention to another possible cause. What arouses our curiosity is the possibility that triggering of asystole can be linked to a head movement during laryngoscopy and thus, it must be taken into account the possibility of a diagnosis of Arnold-Chiari malformation type I, as a specific treatment is possible. Arnold Chiari malformation type I is a congenital anomaly in which the cerebellum herniates through the foramen magnum into the cervical canal, displacing the lower pons and medulla.[2] This condition may be asymptomatic or may manifest symptoms, such as cerebellar ataxia, intracranial hypertension, or even syncope usually related to movements of the head or Valsalva maneuvers.[3],[4]

Initiation by a brisk head movement when performing laryngoscopy in this patient suggests that the mechanism can also be done by a transient compression of the brainstem. A definitive diagnosis is generally made after an MRI scan. Treatment relies on a surgical procedure aimed at making more space at the site of compression with excellent results. The majority of patients experience partial (80-90%) or complete resolution with few or no complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vinayagam S, Dhanger S. Recurrent asystole during laryngoscopy - A nightmare for the anesthesiologists. Saudi J Anaesth 2019;13:362-4.  Back to cited text no. 1
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2.
Meadows J, Kraut M, Guarnieri M, Haroun RI, Carson BS. Asymptomatic chiari type I malformations identified on magnetic resonance imaging. J Neurosurg 2000;92:920-6.  Back to cited text no. 2
    
3.
Weig SG, Buckthal PE, Choi SK, Zellem RT. Recurrent syncope as the presenting symptom of Arnold-Chiari malformation. Neurology 1991;41:1673-4.  Back to cited text no. 3
    
4.
Alarcón J, Dobato JL, Mateo D, Benito C, Giménez-Roldán S. Arnold-Chiari malformation with multiple paroxysmal manifestations induced by coughing. Neurologia 1992;7:25-9.  Back to cited text no. 4
    




 

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