ABSTRACT: Electrocautery has become an indispensable part of surgical armamentarium. Though a lot has been said about problems associated with its use, electrocautery is being used day in and day out in the surgical practice. Here we are reporting a case of most dreaded and a rare complication, a patient belonging to ASA 1 physical status developing cardiac arrest attributable to electrocautery.

METHODS : A 58 year old male, with no significant comorbidities was posted for left modified radical neck dissection for secondary lymph nodes. General anaesthesia was induced with injection fentanyl 100µg, propofol 100mg, vecuronium 6mg and maintained with isoflurane 0.6% in nitrous oxide and oxygen. The patient was haemodynamically stable for next 2 hours. As the surgeon was dissecting near the level III lymph nodes, sinus rhythm changed to ventricular fibrillation and there was no palpable pulse. Resuscitation with chest compression, defibrillation and emergency medications was initiated to restart the heart quickly and the patient ultimately made full recovery.

RESULTS : Traditional teaching suggests that there is high risk of cardiac arrest during operations in very vulnerable areas such as head and neck, thorax etc., especially where the use of electrocautery is inevitable. Electrical interference with ECG calls for extreme vigilance as often changes on the monitor are attributed to this interference, delaying the recognition of the arrhythmias as a complication.

CONCLUSIONS : Prompt vigilance and awareness during surgery especially around neck can help us in preventing fatal events like cardiac arrest and allows prompt remedial measures.