[Case of coronary vasospasm during lumbar discectomy in prone position]

A 62-year-old man with hypertension was scheduled for discectomy at L4-5 in prone position. Anesthesia was induced with propofol 70 mg, fentanyl 0.75 mg and rocuronium 40 mg and maintained with sevoflurane 0.8-2.0% in oxygen 2 l x min(-1) and nitrous oxide 2 l x min(-1). Just before the end of surgery, ST elevation with hypotension on the ECG was observed for only a few seconds, followed by ventricular fibrillation (Vf). Immediately, lidocaine 50 mg, nitroglycerine 0.5 mg and methoxamine 6 mg were administered intravenously, and sinus rhythm and normal blood pressure returned from Vf within one minute. This case achieved a complete response to quick administration of the coronary vasodilator and antiarrhythmic agent, in this case whose coronary spasm was suspected on the basis of ST elevation in the first place. We have to be careful of various initiating factors for coronary spasm each time during anesthesia as it is difficult to assess its clinical risk, especially in prone position because actual coronary flow is much lower and cardiac resuscitation is difficult in a sudden cardiac complication.