When the “simple spinal” isn’t so simple. 49-year-old male. Posted… — Anaesthesia Made Easy 🩺💉🚑 — TG.ME

When the “simple spinal” isn’t so simple. 49-year-old male. Posted for ACL reconstruction. Fit on paper. No red flags. Plan: Subarachnoid block. Spinal given uneventfully. Adequate level achieved. Vitals stable initially. Then it hit. Sudden bradycardia + hypotension. Patient complained of nausea, dizziness. Classic picture unfolding — vasovagal shock post-SAB. Here’s the thing — this is often underestimated. Not all post-spinal hypotension is just “sympathetic block.” This was a Bezold–Jarisch reflex–mediated event. Reduced venous return → hypercontractile empty ventricle → vagal surge. Management was immediate and decisive: Rapid IV fluids Glycopyrrolate for bradycardia Phenylephrine to restore vascular tone Oxygen + reassurance Hemodynamics stabilized quickly. Surgery proceeded uneventfully. ⸻ Why this matters: In ortho cases like ACL — especially in relatively healthy patients — we tend to relax after a smooth spinal. That’s exactly when this can catch you off guard. ⸻ Clinical takeaway: 👉 A falling heart rate after SAB is not benign. Treat it early. 👉 Think beyond “just hypotension” — recognize the reflex. 👉 Your response time defines the outcome. ⸻ Moments like this are why vigilance never drops — even in “routine” cases. #Anaesthesia #SpinalAnaesthesia #RegionalAnaesthesia #Orthopaedics #PatientSafety #PerioperativeCare #CardiacAnaesthesia #Reflexes #ClinicalJudgment LinkedIn