1/5. Coronary artery spasm and non-Q-wave myocardial infarction following intravenous ephedrine in two healthy women under spinal anaesthesia.Vasovagal episodes occur frequently in young healthy patients undergoing venous cannulation and loco-regional anaesthesia. We report two cases of severe coronary vasospasm and non-Q-wave infarction in healthy young women after administration of ephedrine for vasovagal symptoms at the onset of spinal anaesthesia. In the light of unopposed vagal predominance pre-disposing patients to coronary vasospasm, even in young healthy patients, atrophine and not ephedrine should be the first line treatment for bradycardia with or without hypotension under spinal anaesthesia.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. Coronary artery spasm induced by carotid sinus stimulation during neck surgery.We observed four transient episodes of marked ST-segment elevation in a 58-yr-old man with no history of coronary artery disease undergoing resection of a metastatic neck mass under general anaesthesia. Elevations of the ST segment were abrupt, with no change in arterial pressure or heart rate, and resolved spontaneously. When the carotid sinus was compressed directly, ST-segment elevation was noted 1 min after the onset of stimulation. After surgery, coronary angiography showed diffuse, slight narrowing of the distal bed of the posterolateral branch of the right coronary artery. ergonovine caused total occlusion of the posterolateral branch of the right coronary artery with chest pain and ST-segment elevation, confirming the diagnosis of variant angina. The coronary artery spasm seems to have been provoked by vagal activation from carotid sinus stimulation during general anaesthesia.- - - - - - - - - - ranking = 0.28571428571429keywords = anaesthesia (Clic here for more details about this article) |
3/5. Management of unexpected coronary artery spasm in an asymptomatic patient during anaesthesia.We report a case of life-threatening arrhythmia that was not predicted before surgery. pulse-less ventricular tachycardia and ventricular fibrillation occurred during surgery without any changes in heart rate and blood pressure, and cardiac massage was required to maintain circulation. Although no organic stenosis was found in either the right or left coronary arteries, post-surgical angiographic examination revealed severe vasospastic angina induced by intra-luminal administration of acetylcholine. Anaesthesia with a high dose of fentanyl and vasodilators prevented the recurrence of life-threatening arrhythmia. Vasospastic angina attacks are difficult to predict with the preoperative examination routinely employed.- - - - - - - - - - ranking = 0.57142857142857keywords = anaesthesia (Clic here for more details about this article) |
4/5. Coronary artery spasm during non-cardiac surgical procedure.A case of coronary artery spasm during a non-cardiac surgical procedure is presented. Two paroxysmal episodes of ST segment elevation in lead 11 and aVF without changes in V5 developed during general anaesthesia. These changes were not preceded by increases in heart rate or arterial pressure. The second episode was associated with a ventricular bigeminal rhythm. This case demonstrates the importance of monitoring several leads in patients likely to develop peroperative spasm of the coronary arteries. Intravenous nitroglycerin was effective in treating the second episode of coronary artery spasm. However, this episode occurred in spite of nitroglycerin administered intravenously at a rate of 0.25 microgram/kg min.- - - - - - - - - - ranking = 0.14285714285714keywords = anaesthesia (Clic here for more details about this article) |
5/5. Coronary artery spasm induced under lumbar epidural anaesthesia.A case of coronary artery spasm during lumbar epidural anaesthesia prior to surgery is presented. Three paroxysmal episodes of ST segment elevation in lead II without changes in V5 developed concomitantly when the patient complained of chest discomfort. A denervation of the cardiac sympathetic nerve seems to be the primary genesis of the attack in a patient prone to such events.- - - - - - - - - - ranking = 0.71428571428571keywords = anaesthesia (Clic here for more details about this article) |