Coronary artery spasm following mannitol administration during partial nephrectomy: A case report

Area of Science:

• Cardiology
• Nephrology
• Anesthesiology

Background:

• Coronary vasospasm (CAS) is linked to autonomic imbalance and can cause severe cardiac events, especially in variant angina patients.
• Mannitol, a renal protectant, may activate the sympathetic nervous system, posing a risk for CAS in susceptible individuals.
• This case report addresses the rare cardiac risks of mannitol-induced CAS during robotic-assisted surgery.

Purpose of the Study:

• To report a rare case of mannitol-induced coronary vasospasm (CAS) during robotic-assisted surgery.
• To emphasize the potential cardiac risks of mannitol in patients with undiagnosed coronary hyperreactivity.
• To highlight the importance of individualized perioperative management and cardiovascular monitoring.

Main Methods:

• A 66-year-old male underwent robotic-assisted partial nephrectomy.
• The patient received a high-dose mannitol infusion (75 g) and subsequently developed ventricular premature contractions and ventricular fibrillation.
• Transthoracic echocardiography, coronary angiography, and a coronary spasm provocation test were performed.

Main Results:

• Circulation was restored via cardiopulmonary resuscitation and defibrillation.
• Coronary angiography revealed no significant stenosis, but a spasm provocation test confirmed significant CAS and variant angina.
• The patient recovered without neurological deficits and was treated with calcium channel blockers.

Conclusions:

• High-dose mannitol can precipitate life-threatening cardiac events in patients with underlying coronary hyperreactivity.
• Personalized perioperative management and vigilant cardiovascular monitoring are crucial for high-risk patients.
• Alternative renal protection strategies should be considered to mitigate the risk of mannitol-induced CAS.