Acute hypotension and bradycardia by medulla oblongata compression in spinal surgery

A 71-year-old man was admitted to the hospital with subarachnoid hemorrhage caused by a cervical dural arteriovenous shunt. During surgery, the patien t developed acute hypotension and bradycardia, probably caused by surgical compression of the medulla oblongata. During posterior fossa and upper cerv ical surgery, monitoring cardiovascular, respiratory, and evoked potential parameters is advocated. In the current case, only cardiovascular monitorin g detected alteration of brain stem function. Anesthesiologists should be a ware that surgical manipulation of the dorsal medulla might cause hemodynam ic changes and expose patients to danger. Through close cardiovascular moni toring we can rapidly detect changes in vital signs, which allows prompt in tervention to prevent irreversible neurologic deficits and potentially cata strophic patient outcome.