This refers to the article ’Cardiac arrest following central venous catheterization’ (MJAFI 1996; 52: 204-5).
I must compliment the authors for presenting such a rare complication of central venous catheterization.
In elderly patients vagal tone is high. So these patients are prone to develop sudden bradycardia due to any stimulus. In this case atropine would have been a better choice in premedication.
The patient developed irregular pulse followed by bradycardia as the catheter was being advanced. In this case stimulation of SA node by the catheter tig was probably a cause of sudden bradycardia. Also light-plane of GA could have contributed to bradyarrhythmia. In such a situation atropine is the drug of choice to be administered intravenously and not adrenaline. Immediate atropine administration when patient developed bradycardia, would have probably prevented occurrence of asystole.
The patient was connected to ECG monitor but the authors have not mentioned the type of arrhythmia developed initially.
As the internal jugular vein was selected for cannulation, it should not have been introduced to its fullest length as the distance up to right atrium is short.