Intra-operative bradycardia poses significant risks during surgery and may be triggered by various iatrogenic stimuli, including pneumoperitoneum, hypovolemia, increased vagal tone, and airway suctioning. However, mechanical manipulation of the spermatic cord is an underrecognized cause.

We report the case of a 27-year-old male with no known medical history, diagnosed with left testicular cancer and scheduled for left orchiectomy. Pre-operative evaluation revealed low cardiopulmonary risk (ASA grade II). During surgery, profound bradycardia followed by asystole occurred immediately upon clamping of the spermatic cord. Prompt administration of 1 mg atropine and one minute of cardiopulmonary resuscitation successfully restored cardiac rhythm. The procedure was completed uneventfully thereafter.

Previous literature suggests that traction on the spermatic cord can provoke a vagally mediated bradycardic response due to parasympathetic stimulation. This case demonstrates that not only traction but also clamping or pressure on the spermatic cord can elicit a similar reflex. Immediate release of the clamp, administration of atropine, and adherence to ACLS protocols are critical for management.

Spermatic cord manipulation may trigger severe bradycardia or asystole during orchiectomy. Surgeons and anesthesiologists should remain vigilant to this rare but potentially life-threatening reflex and respond promptly to ensure patient safety.