A Case of Cardiac Arrest Caused by Vasovagal Reflex during Blepharoplasty under Local Anesthesia.

Vasovagal reflex may cause benign self-limiting syncope triggered by factors such as pain and emotional stress. However, rarely, it may cause cardiac arrest requiring urgent resuscitation, which has heretofore not been reported during blepharoplasty. In this report, the case of a 28-year-old man who underwent blepharoplasty under local anesthesia is presented. He suddenly experienced bradycardia and subsequent cardiac arrest during resection of the orbicularis oculi. He was fearful after smelling the unpleasant odor of burned tissue and fainted. He recovered consciousness within 1 min following prompt chest compression. Based on intraoperative conditions and cardiological examinations, vasovagal reflex was considered to be the cause of the cardiac arrest. Blepharoplasty involves multiple factors that can lead to neurocardiogenic syncope, thus increasing the risk for intraoperative syncope and circulatory collapse. Hence, the procedure should be performed under close monitoring with the preparation of staff, intravenous access, drugs, and resuscitation cart to manage possible cardiac arrest.