A cardiovascular collapse occurred in the beach chair position for shoulder arthroscopy under general anesthesia -A case report-

The occurrence of severe hypotension and bradycardia, following placing to the beach chair position from supine during general anesthesia for repair of tendon injury of the rotator cuff of shoulder in a healthy 50 year-old man was described. The Bezold-Jarisch reflex, which is known to inhibit cardiovascular reflex and composed of three kinds of symptoms such as vasodilation, bradycardia and hypotension, has been reported mainly in peripheral nerve block, and may occur during orthostasis, hypovolemia, hemorrhage, supine inferior vena cava compression in pregnancy, interscalene block for shoulder surgery in the sitting position and so on. The bradycardia and hypotension can be more aggravated when causative elements overlaps each other. Anticholinergics and vasopressor were injected intravenously, and position of the patient was changed to the supine position immediately resulting in a normal vital signs dramatically.