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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Rocuronium-induced coronary vasospasm--"Kounis syndrome"
International Journal of Cardiology
|September 23, 2008
Summary
This case report details a patient experiencing hypotension and bradycardia during anesthesia due to rocuronium-induced coronary vasospasm, a rare allergic reaction known as Kounis syndrome.
Area of Science:
- Cardiology
- Anesthesiology
- Allergy & Immunology
Background:
- Kounis syndrome is an acute coronary syndrome associated with allergic reactions.
- Type 1 Kounis syndrome involves coronary artery vasospasm without significant plaque rupture.
Observation:
- A 49-year-old male developed hypotension, bradycardia, and myocardial injury during anesthesia induction with lidocaine, propofol, and rocuronium.
- Coronary arteriography showed vasospasm in disease-free coronary arteries.
- Recurrence of symptoms including hypotension, bradycardia, and ST elevation occurred upon re-administration of rocuronium in the ICU.
Findings:
- The patient's symptoms resolved with diphenhydramine and hydrocortisone, suggesting an allergic etiology.
- A suspected diagnosis of Type 1 Kounis syndrome triggered by rocuronium was made.
- This is the first reported case of rocuronium-induced Type 1 Kounis syndrome.
Implications:
- Rocuronium can precipitate Type 1 Kounis syndrome, characterized by allergic coronary vasospasm.
- Anesthesiologists and cardiologists should consider Kounis syndrome in patients with allergic reactions and acute coronary syndromes.
- Prompt recognition and management with antihistamines and corticosteroids may be crucial for patient outcomes.
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