Background <p>Asystole during suspension laryngoscopy is a rare but potentially life-threatening complication if not promptly identified and treated.</p> Case presentation <p>A 62-year-old Vietnamese man developed sudden asystole during the insertion of a suspension laryngoscope for microlaryngeal surgery. The event was immediately recognized and rapidly reversed through prompt removal of the instrument, initiation of external chest compressions, and administration of intravenous atropine. Vagal reflex triggered by laryngeal stimulation was identified as the likely cause. However, carotid sinus hypersensitivity may have either contributed in conjunction with the vagal reflex or constituted an independent etiology.</p> Conclusion <p>This case highlights that gentle surgical manipulation and avoidance of excessive cervical extension may help prevent severe bradycardia or asystole during suspension laryngoscopy. Vigilant monitoring and readiness for resuscitation remain essential for patient safety during suspension laryngoscopy.</p>