Vagus nerve-induced cardiac arrest during percutaneous nephrolithotomy: a clinical challenge

Vagal overexcitation is a rare trigger of cardiac arrest during percutaneous nephrolithotomy, and is closely related to the abundant vagal branches in the renal hilum region. When surgical instruments or high-pressure perfusion directly stimulate the vagus nerve, sudden bradycardia or even asystole may be triggered. A 56-year-old man undergoing percutaneous nephrolithotomy under general anesthesia experienced cardiac arrest due to vagus nerve stimulation following the injection of a small volume of iohexol into the renal calyx. Cardiopulmonary resuscitation was immediately performed, and the patient was transferred to the intensive care unit for further treatment and discharged after full recovery. This case suggests that cardiovascular events caused by the vagus nerve reflex should be monitored during percutaneous nephrolithotomy, and emergency medicine should be prepared before operations that may stimulate the vagus nerve, such as pyelocentesis or high-pressure perfusion.