Asystole due to vagal reflex in a patient with obstructive sleep apnea during anesthesia intubation with laryngoscope

Obstructive sleep apnea (OSA) is a serious sleep disorder. The complications of OSA are respiratory and cardiovascular events, including bradycardia, tachycardia, and even cardiac arrest. A 57-year-old female with OSA was vulnerable to vagal stimulation, developing severe bradycardia and asystole during general anesthesia while undergoing intubation with a conventional direct laryngoscope. This asystole case highlights the fact that anesthetized patients with OSA may experience increased parasympathetic activity (vagal tone) and vagal stimulation with consequent severe bradycardia and asystole. Atropine is recommended to resolve such conditions.