# Cardiac arrest complicating routine throat pack insertion in oral and maxillofacial surgery under general anesthesia: A case report

## TL;DR

A patient experienced cardiac arrest during a routine throat pack insertion during surgery, likely due to a rare vagal reflex.

## Contribution

This case report highlights a rare complication of throat pack insertion under general anesthesia.

## Key findings

- A 54-year-old male had cardiac arrest after throat pack insertion during third molar extraction.
- The event was likely caused by a vagal reflex, resolved with ephedrine without chest compressions.
- The case emphasizes the need for vigilant monitoring during routine surgical procedures.

## Abstract

Throat packs are routinely inserted during oral and maxillofacial surgery and are generally considered safe. However, severe vagally mediated cardiovascular reflexes can rarely occur during airway or oropharyngeal manipulation. The present study describes a rare case of cardiac arrest directly attributed to throat pack insertion. A healthy 54-year-old male patient underwent third molar extraction under general anesthesia. Immediately following throat pack placement, he developed sudden cardiac arrest with complete electrical asystole lasting ~20 sec. Spontaneous circulation returned rapidly following the intravenous administration of ephedrine (8 mg) without the need for chest compressions. This event was most consistent with a vagal reflex-mediated response. The present case report indicates that vigilant hemodynamic monitoring, adequate ventilation and appropriate anesthetic depth are essential even during routine adjunctive steps, such as throat pack insertion.