Asystole During Suspension Laryngoscopy: Vagal Reflex or Carotid Sinus Hypersensitivity? A Case Report

Background Asystole during suspension laryngoscopy is a rare but potentially life-threatening complication if not promptly identified and treated. Case presentation A 62-year-old man developed asystole during the insertion of a suspension laryngoscope for microlaryngeal surgery. The episode occurred in the setting of a heart rate (HR) below 60 beats per minute after sufentanil administration, then was rapidly reversed through immediate removal of the instrument, initiation of external chest compressions, and administration of intravenous atropine. A vagal reflex (VR) triggered by laryngeal stimulation was identified as the primary cause. However, carotid sinus hypersensitivity (CSH) may have either contributed in conjunction with the vagal reflex or constituted an independent etiology. Conclusions This case underscores the importance of vigilant monitoring and preparedness for resuscitation in the operating theatre to safeguard patient outcomes during suspension laryngoscopy.