[A case of coronary spasm during the operation for lung cancer]

We reported a case of coronary spasm during the operation for lung cancer. A 72-year-old man underwent left upper lobectomy for lung cancer under general anesthesia with the aid of thoracic epidural anesthesia. Preoperative examinations did not reveal any clinical problems in the past. Hypotension and premature ventricular beats were observed for several times during operation due to the compression of the heart and left pulmonary artery by the surgeon's hands in stopping brisk bleeding. After this event, ST-segment of ECG was elevated abruptly. Intravenous administration of nitroglycerin was effective to relieve the coronary spasm in this case. Possible triggering factors were mechanical injury of the coronary artery due to compression of the heart, vagal stimuli under thoracic epidural anesthesia and alpha-stimulating drugs to treat hypotension. The importance of preoperative evaluation of coronary lesions, perioperative treatments with nitrates and calcium-channel blockers, and avoidance of intraoperative triggering factors are emphasized to prevent the coronary spasm.