[Coronary artery spasm during one-lung ventilation]

We experienced a case of coronary artery spasm during one-lung ventilation. A 66-year-old man was scheduled for right upper lobectomy for lung cancer. He had a history of hypertension and cerebral infarction, but without any history or evidence of ischemic heart disease. After induction of general anesthesia, a left-sided double lumen tube was inserted. The patient was placed in the left lateral position, and one lung ventilation was started. Before skin incision, we noticed marked ST elevation on the ECG monitor, after which continuous infusion of nitroglycerin and two lung ventilation were initiated. In several minutes, ST elevation subsided completely. We cancelled the surgery and performed the coronary angiography, which demonstrated normal coronary arteries. A diagnosis of coronary artery spasm was made. Possible triggering factors for coronary artery spasm in this case were considered to be an increase in right ventricular pressure due to one-lung ventilation, and vagal stimulation associated with remifentanil use. The importance of evaluation of preoperative risk factors, avoidance of triggering factors and perioperative treatments are emphasized to prevent the coronary artery spasm.