Brief periods of recurrent reproducible asystole during tibial nailing: a possible variant of the Gallagher Wilkinson reflex.

We present the case of an elderly man who was admitted to hospital following a road traffic accident for fracture fixation of the right tibia. He presented with the comorbid conditions of type 2 diabetes mellitus, systemic hypertension, bronchial asthma, organic brain disorder and probable coronary artery disease. He was administered general anaesthesia for the operation. Intraoperatively, a total of 6 periods of severe bradycardia/asystole were noticed, lasting from 2 s to 6 s, which resolved spontaneously. This correlated with the timing of intramedullary reaming and returned to sinus rhythm on release of pressure. All possible differential diagnoses such as a coronary event, fat embolism, pulmonary thromboembolism, overdose of anaesthetic drugs and bone cement implantation syndrome were considered and ruled out. He did not have any further episodes after the surgery and the postoperative period was uneventful. Hence, as a diagnosis of exclusion, a rare manifestation of the Gallagher-Wilkinson reflex can be a possible diagnosis.