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Related Experiment Videos

[Subendocardial infarction on recovery from anesthesia].

T Ishiyama1, N Murakami, T Takeda

  • 1Department of Anesthesia, Gifu City Hospital.

Masui. the Japanese Journal of Anesthesiology
|December 1, 1991
PubMed
Summary

A patient experienced sudden cardiac arrest during hip replacement recovery, developing ventricular fibrillation and myocardial ischemia. Prompt intervention with coronary angioplasty and balloon pumping successfully treated the acute coronary syndrome.

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Cardiovascular Surgery

Background:

  • A 57-year-old male patient underwent total hip replacement surgery.
  • The patient had no prior history of coronary artery disease.
  • Continuous lumbar epidural analgesia was combined with general anesthesia.

Observation:

  • During anesthesia recovery, the patient experienced sudden hypotension and ventricular fibrillation (Vf).
  • Electrocardiogram (ECG) showed ST elevation in multiple leads (I, II, III, aVF, V2-V6).
  • Coronary angiography revealed total occlusion of the proximal left anterior descending artery (LAD) and 25% stenosis of the proximal right coronary artery.

Findings:

  • The event was attributed to coronary artery spasm during emergence from anesthesia, leading to thrombus formation in the LAD.

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  • The patient recovered from myocardial ischemia following percutaneous transluminal coronary recanalization and intraaortic balloon pumping.
  • Subsequent surgeries on postoperative days 4 and 8 were uneventful under general anesthesia.

    • Implications:

    • This case highlights a rare but serious complication of anesthesia, potentially leading to acute myocardial infarction.
    • Early recognition and intervention are crucial for managing perioperative cardiac events.
    • Anesthetic management strategies may need consideration in patients with undiagnosed coronary artery disease undergoing major surgery.