Extreme intraoperative bradycardia during total thyroidectomy: A case report

Severe bradycardia in the operating room is uncommon during thyroid surgery but may occur during deep cervical maneuvers due to vagal or carotid sinus stimulation. We report the case of a 52-year-old female, ASA II, operated on for a compressive multinodular euthyroid goiter, who developed extreme bradycardia at 24 beats/min with hypotension at 68/35 mmHg at the time of right lateral-tracheal traction during dissection of the superior pole. Immediate cessation of the surgical maneuver, 100% oxygenation, administration of atropine 1 mg IV followed by ephedrine 6 mg IV led to rapid hemodynamic recovery. There was no evidence of hypoxia, hypercapnia, electrolyte disturbance, anaphylaxis, or acute coronary event. The most likely mechanism was a cardioinhibitory reflex due to carotid stimulation or increased vagal tone. This case highlights the need for early recognition, immediate communication between surgeon and anesthetist, and management in accordance with recommendations for symptomatic bradycardia.