Torsade de pointes ventricular tachycardia following coronary artery spasm during general anaesthesia

We present a patient who suffered two episodes of torsade de pointes ventricular tachycardia during general anaesthesia for abdominal surgery. The first occurred on suctioning of the tracheobronchial tree and the second while anaesthesia was light. Since ST segment elevation was in each case noted before the onset of torsade de pointes, coronary artery spasm was suspected to be the cause. An intravenous infusion of nitroglycerine was effective in treating and preventing these episodes. These findings suggest that coronary artery dilators such as nitroglycerine are indicated for initial treatment of torsade de pointes following coronary artery spasm in order to facilitate recovery from myocardial ischaemia.