Question

An anaesthesia resident was giving epidural anaesthesia when the patient had sudden aphonia and loss of consciousness. What could have happened?

• A. Total spinal anaesthesia
• B. Anaphylaxis
• C. Vasovagal attack
• D. Intravascular injection

Hint:

Sudden, transient faint at the moment of instrumentation points to a reflex autonomic event.

Answer 1

The Correct Option is C

Step 1: Read the clinical picture.
During epidural placement the patient suddenly develops aphonia (inability to phonate) and loss of consciousness. The event is abrupt and self-limiting in the classic recall scenario, pointing toward a transient drop in cerebral perfusion rather than a drug effect.

Step 2: Understand a vasovagal attack.
A vasovagal (neurocardiogenic) reaction is triggered by pain, anxiety or instrumentation. Increased vagal tone causes bradycardia and vasodilatation, blood pressure falls, cerebral perfusion drops, and the patient suddenly loses consciousness. Transient cerebral hypoperfusion can produce momentary aphonia just before or as the patient faints.

Step 3: Exclude the distractors.
Total spinal anaesthesia causes hypotension with apnoea and unresponsiveness, but it develops over a short period after intrathecal spread, not as an instantaneous faint during needle placement. Anaphylaxis presents with urticaria, bronchospasm, angioedema and circulatory collapse rather than isolated sudden aphonia. Intravascular (local anaesthetic systemic) injection causes perioral tingling, tinnitus, seizures and cardiac toxicity.

Step 4: Conclusion.
The sudden, transient aphonia with loss of consciousness during the procedure is most consistent with a vasovagal attack.

Correct answer: Vasovagal attack.