Management of unexpected coronary artery spasm in an asymptomatic patient during anaesthesia

We report a case of life-threatening arrhythmia that was not predicted before surgery. Pulse-less ventricular tachycardia and ventricular fibrillation occurred during surgery without any changes in heart rate and blood pressure, and cardiac massage was required to maintain circulation. Although no organic stenosis was found in either the right or left coronary arteries, post-surgical angiographic examination revealed severe vasospastic angina induced by intra-luminal administration of acetylcholine. Anaesthesia with a high dose of fentanyl and vasodilators prevented the recurrence of life-threatening arrhythmia. Vasospastic angina attacks are difficult to predict with the preoperative examination routinely employed.