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Vasovagal reflex may cause benign self-limiting syncope triggered by factors such as pain and emotional stress. However, rarely, it may cause cardiac arrest requiring urgent resuscitation, which has heretofore not been reported during blepharoplasty. In this report, the case of a 28-year-old man who underwent blepharoplasty under local anesthesia is presented. He suddenly experienced bradycardia and subsequent cardiac arrest during resection of the orbicularis oculi. He was fearful after smelling the unpleasant odor of burned tissue and fainted. He recovered consciousness within 1 min following prompt chest compression. Based on intraoperative conditions and cardiological examinations, vasovagal reflex was considered to be the cause of the cardiac arrest. Blepharoplasty involves multiple factors that can lead to neurocardiogenic syncope, thus increasing the risk for intraoperative syncope and circulatory collapse. Hence, the procedure should be performed under close monitoring with the preparation of staff, intravenous access, drugs, and resuscitation cart to manage possible cardiac arrest.

Abstract The Glasgow Prognostic Score (GPS) has been established as a useful resource to evaluate inflammation and malnutrition and predict prognosis in several cancers. However, its prognostic significance in patients with heart failure (HF) is not well established. To investigate the association between the GPS and mortality in patients with HF, we assessed 870 patients who were 20 years old and more and had been admitted for acute decompensated HF. The GPS ranged from 0 to 2 points as previously reported. Over the 18-month follow-up (follow-up rate, 83.9%), 143 patients died. Increasing GPS was associated with higher HF severity assessed by New York Heart Association functional class and B-type natriuretic peptide (BNP) levels. Kaplan–Meier analysis showed significant associations for mortality and increased GPS. In multivariate analysis, compared to the GPS 0 group, the GPS 2 group was associated with high mortality (hazard ratio 2.92, 95% confidence interval 1.77–4.81, p