A Case of Coronary Artery Spasm Possibly due to Inadequate Anesthesia as Indicated by Bispectral Index

• Published in: CIRCULATION CONTROL Vol. 26; no. 4; pp. 335 - 337
• Main Authors: Honda, Yasuko, Hino, Hirofumi, Nishikido, Osamu, Sasano, Jun, Obata, Yumi, Tateda, Takeshi
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Circulation Control in Medicine 2005
• Subjects: bispectral index:BIS; coronary spasm; inadequate depth of anesthesia
• ISSN: 0389-1844
• DOI: 10.11312/ccm.26.335

A case of coronary artery spasm that occurred during inadequate anesthesia, as indicated by the bispectral index(BIS) is described. A 73-year-old man with a history of variant angina was scheduled for left upper lobectomy because of lung cancer. Surgery was to be performed under general anesthesia combined with thoracic epidural anesthesia. Preoperative examination showed only complete right bundle branch block on the electrocardiogram(ECG). Anesthesia induction and intubation were uneventful. Anesthesia was maintained with nitrous oxide in oxygen, propofol and epidural block. The patient's systolic arterial pressure decreased sud-denly to about 70mmHg upon surgical manipulation of the heart, but there was no remarkable ST-T change on the ECG. The administration of propofol was terminated, and 5mg of ephedrine was injected with 100% oxygen. The BIS rose from 40 to 70. After normal systemic pressure was achieved, the ECG showed ST segment elevation. Isosorbide and nicorandil were administered, and the ST segment returned to normal. It is possible that the inadequate anesthesia, the administration of ephedrine, or both were the cause of the coronary artery spasm in this case. We should be aware of the possibility of coronary artery spasm under these conditions.