[Coronary spasm during laryngoplasty].
A 63-yr-old man weighing 56kg was scheduled for pharyngoplasty under general anesthesia. The patient had no history of ischemic heart disease. Preoperative ECG showed incomplete right branch block. We administered thiopental and succinylcholine for intubation. Anesthesia was maintained with enflurane, nitrous oxide, oxygen and pancuronium bromide. Thirty minutes after the start of incision, the patient developed a severe hypotension and ECG revealed ST elevation and complete AV block. We administered ephedrine hydrochloride, phenylephrine hydrochloride and atropine sulfate. The ECG returned to sinus rhythm but ST segment was depressed this time. We considered it due to coronary spasm, so we started continuous intravenous administration of nitroglycerin (0.5 microgram. kg-1. min-1). One hour later, ST segment returned to normal. ECG showed no remarkable changes and no symptoms were seen after the operation. We found it important to suspect coronary spasm when ECG showed PVC-like abnormal waves with ST elevation. We consider that continuous administration of nitroglycerin at a rate of 0.5 microgram. kg-1. min-1 was effective for the treatment of coronary spasm in this case.
Tatara
T
T
Department of Anaesthesiology, Saitama Medical Center, Saitama Medical School, Kawagoe.
Kuroda
T
T
Miyao
H
H
Kawasaki
J
J
Shigematsu
T
T
Kawazoe
T
T
D003329:Coronary Vasospasm / Q000209:etiology*; D006801:Humans; D007432:Intraoperative Period; D007830:Larynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged