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Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery
Published on: January 6, 2011
Coronary artery vasospasm during awake deep brain stimulation surgery
1Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S102JF, UK.
British Journal of Anaesthesia
|June 7, 2008
Summary
Coronary vasospasm can cause myocardial damage, mimicking heart attacks. Early recognition and nitrate treatment are crucial, especially during awake deep brain stimulation surgery, necessitating vigilant monitoring and anesthesia presence.
Area of Science:
- Cardiology
- Neurosurgery
- Anesthesiology
Background:
- Coronary vasospasm, often occurring with normal coronary arteries, presents clinically similar to ischemic heart disease.
- Myocardial damage can result from vasospasm, evidenced by ECG changes and elevated troponin levels.
Observation:
- Patients undergoing awake deep brain stimulation (DBS) surgery are vulnerable to distress if vasospasm occurs.
- The case report highlights the potential for significant patient distress during DBS if vasospasm is not managed.
Findings:
- Prompt recognition and treatment, often with nitrate therapy, can effectively resolve coronary vasospasm.
- ECG changes and troponin rises indicate actual myocardial damage in cases of vasospasm.
Implications:
- Mandatory full patient monitoring and anesthesia presence are recommended for all deep brain stimulation surgeries.
- Patients with a history of cardiac disease or vasospasm require 5-lead ECG monitoring and premedication with beta-blockers and nitrates.
