title: Sudden cardiac arrest in general anesthesia as the first manifestation of anomalous origin of the left coronary artery.
abstract: OBJECTIVE
  This case report describes a rare and potentially fatal condition associated with anesthesia administration. Our aim was to discuss the causes of sudden cardiac arrest during the perioperative period in apparently healthy patients and the pathophysiology of anomalous origin of the coronary arteries as a cause of sudden cardiac arrest.
  
  
  METHODS
  Female patient, 44 years old, with no previous symptoms of heart disease or arrhythmias, had a sudden cardiac arrest during general anesthesia in two different situations. In the first episode, the patient presented signs of acute abdomen, but remained hemodynamically stable. Following induction of anesthesia, the patient exhibited bradycardia and hypotension refractory to volume replacement and vasopressors. The condition progressed to asystole. The patient was successfully resuscitated and discharged from the hospital in good condition. In the second episode, one year after the first, the patient was in good clinical condition to undergo an elective surgery. After induction of anesthesia, the patient developed ventricular tachycardia followed by asystole, which was promptly reversed. After extensive investigation, an anomalous origin of the left coronary artery was identified.
  
  
  CONCLUSIONS
  Our report is illustrative as it emphasizes that a thorough diagnostic investigation should be done in cases of sudden cardiac arrest during the perioperative period, even in patients that appear to be healthy.
authors.affiliation: Anesthesiology Department, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brazil. mdagomes@gmail.com
authors.forename: Maurício
authors.initials: M
authors.lastname: Daher
authors.forename: André Rodrigues
authors.initials: AR
authors.lastname: Zanatta
authors.forename: Benhur David
authors.initials: BD
authors.lastname: Henz
authors.forename: Marcelo Carneiro
authors.initials: MC
authors.lastname: da Silva
authors.forename: Simone Nascimento
authors.initials: SN
authors.lastname: dos Santos
authors.forename: Luiz Roberto
authors.initials: LR
authors.lastname: Leite
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000175:diagnosis*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006801:Humans