Asystole Following Jaw Thrust Maneuver: A Case Report

Abstract

The jaw thrust maneuver is a fundamental airway management tool to prevent the tongue from obstructing the upper airway in unconscious patients. Known complications of the jaw thrust maneuver include spinal cord injury if the cervical spine is unstable and exacerbation of an existing mandibular injury. However, this procedure is frequently associated with pain, and the associated consequences, especially the parasympathetic response, are rarely seen or discussed. We report a rare complication of a 38-year-old healthy female emerging from general anesthesia who developed transient but severe bradycardia leading to asystole following a jaw thrust maneuver. We conclude that the bradycardia and asystole resulted from the vagal response to the pain induced by the jaw thrust.

Keywords: asystole; bradycardia; jaw-thrust maneuver; pain; parasympathetic; vasovagal.

Figure 1. Intraoperative monitoring data

A: The SpO2, BP, and ETCO2 monitoring graph every five minutes for the whole procedure. B: The monitor graph for every minute around the time of the incident shows a significant drop in HR recorded at around 08:39 from baseline (black arrow). However, asystole was not recorded due to the transient course. C: The monitoring data at 08:39 showed an HR of 43 bpm compared with baseline 60s. D: A 'quick note' of the incident. SpO2: Pulse oxygen saturation, BP: Blood pressure, ETCO2: End-tidal carbon dioxide, HR: Heart rate, bpm: Beats per minute

Figure 2. The first EKG done one hour after surgery shows sinus bradycardia and arrhythmia, likely the cardiac consequence of prior asystole.

Figure 3. The second EKG done 1.5 hours after surgery shows normal sinus rhythm, and no arrhythmias.