A Hypotensive/Bradycardic Episode Leading to Asystole in a Patient Undergoing Shoulder Arthroscopy in the Sitting Position With Interscalene Block and Intravenous Sedation: A Case Report.

Anesthesia for shoulder surgery is often accomplished by means of an interscalene block and intravenous sedation, with the patient subsequently placed in the sitting position for surgical access. Despite the advantages of this popular technique, sudden unheralded and severe hypotensive/bradycardic episodes have been reported in this population, with an incidence of 13% to 24%. Although these episodes are usually transient and resolve spontaneously, there are case reports of progression to asystolic cardiac arrest following hypotensive/bradycardic episodes. To raise awareness of the catastrophic potential of these episodes and discuss possible causes and preventive measures, the author presents the case of an ASA class 1 patient undergoing shoulder arthroscopy in the sitting position with an interscalene block and intravenous sedation, who experienced a hypotensive/bradycardic episode that rapidly progressed to intraoperative asystole.