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Vasovagal Syncope Day Surgery — FRCA Final MCQ

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EasyDay SurgeryVasovagal Syncope Day SurgeryFRCA Final

A 48-year-old man (ASA II) is having a vasectomy under local anaesthesia in the day surgery unit. He becomes pale, sweaty, bradycardic (HR 38), and hypotensive (BP 75/40) during the procedure. He has not received any sedation. What is the most likely cause?

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Correct answer: C — Vasovagal syncope

Vasovagal syncope (neurocardiogenic syncope) is the most common cause of bradycardia and hypotension during surgical procedures under local anaesthesia, triggered by pain, anxiety, or surgical stimulation (particularly testicular manipulation which has a strong vagal response). The classic presentation is pallor, sweating, nausea, bradycardia, and hypotension. Management: stop stimulation, lay flat/Trendelenburg, IV fluids, and atropine 0.5 mg IV if bradycardia is severe or persistent. Recovery is usually rapid. LA toxicity would present with CNS symptoms first.

Reference: RCOA – 2023 – Day surgery module; BADS – 2019 – Management of complications in day surgery