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[Coronary artery spasm under general and epidural anesthesia]
Y Shimoda1, O Kimura, Y Miyate
1Department of Anesthesia, Iwate Prefectural Central Hospital, Morioka.
Masui. the Japanese Journal of Anesthesiology
|February 1, 1993
Summary
Hypotension during surgery may trigger coronary artery spasm, leading to heart rhythm issues. Promptly restoring blood pressure resolved these cardiac events, suggesting a link between low blood pressure and myocardial ischemia.
Area of Science:
- Cardiology
- Anesthesiology
- Gastrointestinal Surgery
Background:
- A 66-year-old male underwent subtotal gastrectomy under combined epidural and general anesthesia (nitrous oxide, isoflurane).
- The patient had no prior history of angina pectoris.
Observation:
- Hypotension occurred during the procedure, followed by ST-segment elevation on ECG.
- The patient developed Wenckebach atrioventricular (A-V) block and subsequently complete A-V block.
- ST-segment elevation resolved, and sinus rhythm was restored upon increasing blood pressure.
Findings:
- Serum cardiac enzyme levels (CPK-MB, GOT, LDH) remained normal post-operatively.
- The cardiac events are suspected to be induced by coronary artery spasm.
- Potential triggers include hypotension and vagal stimulation under inadequate anesthesia levels.
Implications:
- This case highlights the potential for intraoperative hypotension to precipitate coronary artery spasm and conduction abnormalities.
- Maintaining adequate blood pressure and anesthesia depth is crucial in patients undergoing surgery, especially those with potential cardiac risk factors.
- Further investigation, potentially including arteriography, may be needed to definitively diagnose coronary spasm in similar clinical scenarios.