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Peri-Arrest Bradycardia Obstetric Spinal — FRCA Final MCQ

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HardObstetric AnaesthesiaPeri-Arrest Bradycardia Obstetric SpinalFRCA Final

A 38-year-old woman (ASA I, 65 kg) at 39 weeks gestation has an elective caesarean section under spinal anaesthesia. After delivery, she develops profound bradycardia (HR 28) and hypotension (BP 55/30) despite phenylephrine. She becomes unresponsive. What is the initial drug and dose?

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Correct answer: D — Adrenaline 100 mcg IV then start infusion if needed

Profound bradycardia with cardiovascular collapse during spinal anaesthesia in obstetrics (Bezold-Jarisch reflex or high/total spinal) that is unresponsive to first-line vasopressors and atropine requires adrenaline. In a peri-arrest situation: adrenaline 100 mcg IV (0.1 mL of 1:10000 or 1 mL of 1:100000), repeated and titrated. If cardiac arrest occurs: standard doses (1 mg IV). Atropine may help mild bradycardia but is insufficient alone for cardiovascular collapse. The OAA QRH recommends having adrenaline pre-drawn and available for all obstetric spinals.

Reference: OAA – 2024 – QRH: High/total spinal; Resuscitation Council UK – 2021 – Bradycardia algorithm