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[Coronary artery spasm during low flow anesthesia]
Y Morita1, M Sanuki, H Kinoshita
1Department of Anesthesia and Intensive Care, Hiroshima City Asa Hospital, Hiroshima 731-0293.
Masui. the Japanese Journal of Anesthesiology
|January 19, 2002
Summary
A 70-year-old man experienced intraoperative coronary spasm during aorto-femoral bypass graft surgery. Hypotension and inadequate anesthesia likely triggered the event, highlighting the need for sufficient anesthetic levels.
Area of Science:
- Cardiology
- Anesthesiology
- Vascular Surgery
Background:
- A 70-year-old male patient underwent aorto-femoral bypass graft surgery.
- The patient had no prior history of angina pectoris.
- Anesthesia was administered via epidural block, supplemented with nitrous oxide and sevoflurane.
Observation:
- During low-flow anesthesia (2 L/min), the patient developed hypotension approximately 20 minutes into the procedure.
- Electrocardiogram (ECG) monitoring revealed ST-segment elevation, indicative of myocardial ischemia.
- The ST-segment elevation resolved, and circulatory stability was achieved after blood pressure was raised and nitroglycerin was administered.
Findings:
- The intraoperative ST-segment elevation was suspected to be a coronary spasm attack.
- Potential triggers included hypotension and vagal stimulation due to insufficient anesthetic depth.
- This suggests a link between anesthetic management and coronary artery events during major surgery.
Implications:
- Maintaining adequate anesthesia levels is crucial for preventing intraoperative coronary spasm.
- Utilizing patient monitors is essential for assessing anesthetic depth and hemodynamic stability.
- Proactive management of anesthesia can mitigate risks of myocardial ischemia in surgical patients.