[A case of coronary artery spasm during burr hole opening for craniotomy]

We report a rare case of coronary artery spasm during burr hole opening for craniotomy in a patient with no past history of coronary artery disease. A 52-year-old man was scheduled for the removal of the brain tumor under general anesthesia. Anesthesia was induced with fentanyl, thiamylal, and vecuronium, and maintained with sevoflurane plus nitrous oxide in oxygen. When burr holes were made for the craniotomy, the heart rate decreased suddenly and the ECG in lead II demonstrated the elevation of the ST segment (0.3mV). After about 1 min, the ST segment elevation returned to normal without any treatment. The dura mater was rather tense with inspection. Despite many reported cases of coronary artery spasm during general anesthesia, coronary artery spasm during burr hole opening for craniotomy has not been reported. In the present case, since the heart rate decreased and the elevation of the ST segment occurred at the time of the burr hole opening for craniotomy, the activated vagal tone reflex induced by the stimulation of the dura mater seemed to have caused the coronary artery spasm.