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[Coronary artery spasm under thoracic epidural anesthesia].
Masui. the Japanese Journal of Anesthesiology
|October 1, 1989
Summary
Thoracic epidural anesthesia may induce coronary artery spasm, leading to serious cardiac events like ventricular tachycardia and heart block. Prompt treatment with medications and interventions can manage these episodes.
Area of Science:
- Cardiology
- Anesthesiology
Background:
- Variant angina and coronary artery obstruction increase cardiac risk during surgery.
- Thoracic epidural anesthesia can affect autonomic nervous system balance.
Observation:
- A patient with coronary artery disease experienced ST-segment elevation, ventricular tachycardia, and heart block during bullectomy under thoracic epidural anesthesia.
- These events were preceded by decreased heart rate and blood pressure, suggesting coronary artery spasm.
Findings:
- Coronary artery spasm was suspected due to increased vagal tone and blocked cardiac sympathetic nerves under epidural anesthesia.
- Initial episodes responded to nitroglycerin and lidocaine; a third severe episode required multiple medications and direct heart massage.
- Postoperative ECG changes and elevated cardiac enzymes were noted, but with a low ratio of CPK-MB to total CPK.
Implications:
- Thoracic epidural anesthesia may precipitate coronary artery spasm in susceptible patients.
- Close cardiac monitoring and preparedness for managing vasospastic events are crucial during procedures involving thoracic epidural anesthesia.
- Understanding the interplay between anesthesia, vagal tone, and coronary perfusion is vital for patient safety.