Case of sudden asystole during direct laryngoscopy

A 78-year-old man, weighing 74 kg and 172 cm in height suddenly developed asystole during direct laryngoscopy. His heart started beating soon after chest compressions. Direct larygoscopy can stimulate the vagal nerve of the larynx. Although a gradual decrease in heart rate ordinarily occurs prior to asystole, few reports describe the sudden asystole during direct laryngoscopy. Intravenous injection of atropine could avoid the adverse event. Anesthesiologists should pay attention to the occurence of asystole and prepare for resuscitation.