[Intraoperative coronary spasm during caesarean section under spinal anesthesia].
A 37-year-old woman without history of ischemic heart disease or any coronary risk factors was scheduled for caesarean section. Under spinal anesthesia, the patient's blood pressure (BP) decreased to 93/72 mmHg. Although 6 mg of ephedrine was administered intravenously, BP continued to decrease to 75/40 mmHg and she complained of nausea. In addition to additional ephedrine (12 mg), phenylephrine (0.1 mg) and atropine (0.5 mg) were administered. BP increased to 170/100 mmHg, but electrocardiogram (ECG) showed ST elevation in I and aV(L), ST depression in II, III, aV(F), and frequent premature ventricular beats, and the patient complained of chest discomfort. Coronary dilators and lidocaine promptly reversed the ST elevation, premature ventricular beats and discomfort. The operation was started promptly and was uneventful. Although BP decreased again to 75/45 mmHg at the beginning of the operation, we did not use vasopressors to avoid the relapse of myocardial ischemia. The anesthetic course was uneventful thereafter. This cardiac event seemed to be derived from coronary spasm caused by acute sympathetic stimulation. The observations in this case suggest that the possibility of intraoperative coronary spasm should be considered even in a healthy patient.
Kuwajima
Ken
K
Department of Anesthesiology, Faculty of Madicine, The University of Tokyo, Tokyo 113-8655.
Chang
Kyungho
K
Ohno
Nagara
N
Yamada
Yoshitsugu
Y
D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000188:drug therapy; D004562:Electrocardiography; D004809:Ephedrine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy; D007431:Intraoperative Complications / Q000175:diagnosis / Q000188:drug therapy; D011247:Pregnancy; D013566:Sympathomimetics / Q000009:adverse effects / Q000627:therapeutic use
D013566:Sympathomimetics; D004809:Ephedrine