Highlights the risk of coronary artery spasm and subsequent ventricular fibrillation during upper abdominal surgery under epidural anesthesia in a patient without prior ischemic heart disease.
May signal coronary spasm risk during epidural anesthesia without prior CAD; hypothesis-generating for monitoring or prevention studies.
The present report describes a case of coronary artery spasm which developed ventricullar fibrillation during upper abdominal surgery under epidural anesthesia. A 58-yr-old male patient with esophageal cancer was scheduled for radical resection and reconstruction of esophagus. He gave no history of ischemic heart disease.A thoracic epidural block from T2 to L3 was performed with 2% mepivacaine and the trachea was intubated with intravenous administration of droperidol (7.5mg), thiopental (175mg) and succinylcholine (60mg). Fifty five minutes after the communication of surgery the electrocardiogram suddenly showed elevation of the ST segment in lead II. Five minutes after elevation of ST segment, ventricullar tachyarrhythmia and ventricullar fibrillation followed.After cardiopulmonary resuscitation, serial electrocardiograms showed within normal limits. Serum enzymes (GOT, GPT, LDH, CPK) were elevated but the isozyme patterns suggested that the elevation of these enzymes was induced by cardioversion.Coronary arteriography demonstrated narrowing in the left and right coronary artery without total obstruction.
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Koga et al. (1983) studied this question.
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