{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:28:51Z","timestamp":1787228931526,"version":"build-2736575974"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Asystole during tracheal intubation using a direct laryngoscope has been reported, but there has been no report of asystole during tracheal intubation using a videolaryngoscope. We report a case of asystole during videolaryngoscopy in a 76-year-old woman with marked tracheal deviation caused by a large thyroid adenoma. General anesthesia was induced with remimazolam 6 mg\/kg\/h, fentanyl 0.1 mg, and remifentanil 0.25 \u03bcg\/kg\/min, under apneic oxygenation using high-flow nasal oxygenation. After administration of rocuronium 40 mg, a McGrath\u2122 MAC videolaryngoscope provided an excellent glottic view. Immediately before tracheal tube insertion, sudden bradycardia progressed to asystole. Laryngoscopy was discontinued, and intravenous atropine 0.5 mg was administered, resulting in the return of spontaneous cardiac activity within 10 s without chest compressions. The patient\u2019s vital signs remained stable after the event, and tracheal intubation was achieved without further complications. Anesthesiologists should remain vigilant for this rare but potentially life-threatening complication.<\/jats:p>","DOI":"10.4103\/sja.sja_218_26","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:02:01Z","timestamp":1782968521000},"page":"726-728","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Asystole during laryngoscopy with a videolaryngoscope in a patient with an anticipated difficult airway: A case report"],"prefix":"10.4103","volume":"20","author":[{"given":"Ryosuke","family":"Osawa","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoi","family":"Tsurumachi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takero","family":"Arai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"R1-20260820","doi-asserted-by":"crossref","first-page":"308","DOI":"10.4103\/1658-354X.101234","article-title":"Severe bradycardia during laryngoscopy in adult neurosurgical patient","volume":"6","author":"Chowdhury","year":"2012","journal-title":"Saudi J Anaesth"},{"key":"R2-20260820","doi-asserted-by":"crossref","first-page":"362","DOI":"10.4103\/sja.SJA_6_19","article-title":"Recurrent asystole during laryngoscopy\u2014A nightmare for the anesthesiologists","volume":"13","author":"Vinayagam","year":"2019","journal-title":"Saudi J Anaesth"},{"key":"R3-20260820","doi-asserted-by":"crossref","first-page":"506","DOI":"10.23736\/S0375-9393.25.18641-0","article-title":"Comparing intubation distances between direct and video laryngoscopes using motion capture: A mannequin study","volume":"91","author":"Tsurumachi","year":"2025","journal-title":"Minerva Anestesiol"},{"key":"R4-20260820","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1007\/s00540-023-03207-2","article-title":"Efficacy of McGRATH\u00aeMAC videolaryngoscope blade 1 for tracheal intubation in small children: a randomized controlled clinical study","volume":"37","author":"Masui","year":"2023","journal-title":"J Anesth"},{"key":"R5-20260820","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1111\/j.1365-2044.2012.07087.x","article-title":"Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScope\u00aevideolaryngoscopy","volume":"67","author":"Russell","year":"2012","journal-title":"Anaesthesia"},{"key":"R6-20260820","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s12871-020-01118-3","article-title":"Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine","volume":"20","author":"Paik","year":"2020","journal-title":"BMC Anesthesiol"},{"key":"R7-20260820","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1002\/lary.25590","article-title":"Severe bradycardia associated with suspension laryngoscopy","volume":"126","author":"Latuska","year":"2016","journal-title":"Laryngoscope"},{"key":"R8-20260820","doi-asserted-by":"crossref","first-page":"5489","DOI":"10.2174\/1381612820666140325102623","article-title":"Effects of remifentanil on the cardiac conduction system. Our experience in the study of remifentanil electrophysiological properties","volume":"20","author":"Narciso","year":"2014","journal-title":"Curr Pharm Des"},{"key":"R9-20260820","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1016\/j.bja.2024.08.036","article-title":"Efficacy of high-flow nasal cannula in improving the view of the glottis during flexible bronchoscopy for tracheal intubation","volume":"135","author":"Osawa","year":"2025","journal-title":"Br J Anaesth"},{"key":"R10-20260820","doi-asserted-by":"crossref","first-page":"111822","DOI":"10.1016\/j.jclinane.2025.111822","article-title":"Hyperkalemia in liver transplantation","volume":"103","author":"Chang","year":"2025","journal-title":"J Clin Anesth"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_218_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:01:38Z","timestamp":1787227298000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_218_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_218_26","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-03-18","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-23","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}