title: [A Case of Cardiac Arrest Caused by Coronary Spasm Related to Induction of General Anesthesia before Carotid Endarterectomy].
abstract: Coronary vasospasm(CV)can cause severe arrhythmia and myocardial infarction(MI). Intraoperative CV is not limited to cardiac surgery alone. We report the case of a patient who experienced cardiac arrest after the induction of general anesthesia, but did not demonstrate any abnormalities on preoperative examination. The patient was a 60-year-old man with no history of ischemic heart disease, with NASCET 80% asymptomatic left internal carotid stenosis(ICS). We decided to perform carotid endarterectomy(CEA). Preoperative stress myocardial scintigraphy did not reveal decreased local uptake. General anesthesia was rapidly induced with propofol and remifentanil, and maintained with sevoflurane. Shortly before the start of CEA, systolic blood pressure dropped to 80 mmHg. Electrocardiography indicated decreased ST, followed by an increase, after which complete atrioventricular block occurred. Cardiopulmonary resuscitation was initiated immediately as the patient's pulse was not palpable;heart beat resumed quickly. CEA was canceled. CV was suspected by the test of nitrate administration to coronary artery performed afterwards. A temporary pacemaker was inserted and carotid artery stenting was performed under local anesthesia. Hence, no pacemaker was used intraoperatively and no abnormality was observed on electrocardiography. In the present case, CV in the coronary artery caused complete atrioventricular block, leading to cardiac arrest after inducing general anesthesia. For ICS treatment performed under general anesthesia, care must be taken regarding the possibility of the occurrence of CV.
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine.
authors.forename: Kimitoshi
authors.initials: K
authors.lastname: Sato
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Abe
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Kosaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ohuchi
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Okamoto
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kumabe
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D003327:Coronary Disease / Q000601:surgery*; D004562:Electrocardiography; D016894:Endarterectomy, Carotid; D006323:Heart Arrest / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D013035:Spasm / Q000601:surgery*; D016896:Treatment Outcome