A Case of Severe Bradycardia Associated with Bladder Perforation during Spinal Anesthesia

Here we report a case of severe bradycardia associated with bladder perforation during transurethral resection of the bladder. The patient was diagnosed with bladder cancer eight months ago and underwent transurethral resection of the bladder tumor. After balloon-occluded arterial infusion chemotherapy, she was scheduled for a bladder biopsy under spinal anesthesia. Spinal anesthesia was induced with 2.5 ml of 0.5% bupivacaine hydrochloride at L3-4, and sensory loss (T9) was confirmed. The operation started uneventfully 20 minutes after bupivacaine administration. However, ten minutes into the operation, bladder perforation occurred and was followed by severe bradycardia (20-30 beats x min(-1)). While preparing for transcutaneous pacing, bradycardia improved with intravenous atropine and ephedrine. The level of spinal anesthesia remained unchanged. General anesthesia was induced with propofol, rocuronium and fentanyl. The patient was extubated uneventfully after the operation and was discharged 14 days later.