What are the problems facing an RAS child during anaesthesia?
The vagus nerve can be stimulated to produce an RAS attack by pressing the eyeballs [the ocular compression test] and, in anaesthesia when the tube is pushed down the throat. If the person is anaesthetised lying flat, after being given a pre-operation dose of atropine, there will be no further complications. Complications arise where, particularly in dental anaesthesia, the RAS sufferer is anaesthetised sitting up. The intubation causes the RAS attack, and because the body is upright the blood falls to the legs. When the fail-safe mechanism restarts the heart the lack of blood in the heart could cause a cardiac arrest. Complications, including brain damage could then ensue. The advice is always tell the anaesthetist that the child or adult has, or did suffer from RAS, and insist that all anaesthesia is administered while the patient is lying flat.
