[Case of cardiac arrest due to coronary spasm during laparoscopic distal gastrectomy]

We describe a 50-year-old man who developed ventricular arrhythmia followed by cardiac arrest during laparoscopic distal gastrectomy. Preoperatively, there were no findings suggesting an ischemic heart disease. Anesthesia was maintained using sevoflurane combined with epidural anesthesia. His blood pressure, heart rate, and ECG waves were stable during the initial stage of laparoscopic procedure. After establishment of small laparotomy for stomach resection, the blood pressure decreased to before 60 mmHg without remarkable ST change on lead II. Administration of intravenous ephedrine was not effective and a short run appeared. Then persistent ventricular tachycardia followed by ventricular standstill developed. Chest compression and intravenous adrenalin restored sinus rhythm, and thereafter the patient remained hemodynamically stable with intravenous nitroglycerine and nicorandil. The operation was completed and the patient awoke without neurological deficits. Postoperatively the coronary angiography showed no stenosis of coronary arteries; however, when acetylcholine test was attempted on right coronary artery, paroxysmal ventricular fibrillation in accordance with spasm of #1 segmental coronary artery developed. In the case of abrupt onset of lethal arrhythmia, coronary vasospasm should be suspected even when ST changes are not recognized with routine ECG monitor.