caa a22 4500 445372923 CHVBK 20180317142953.0 cr unu---uuuuu 170323e20110201xx s 000 0 eng 10.1007/s00540-010-1045-8 doi (NATIONALLICENCE)springer-10.1007/s00540-010-1045-8 A case of intraoperative coronary artery spasm in a patient with vascular disease [Elektronische Daten] [Masaki Ito, Masachika Hayashi, Shin Kagaya, Takeshi Kitoh, Sohtaro Miyoshi] A 66-year-old man with a history of longtime smoking, untreated hypertension, hyperlipidemia, and impaired glucose tolerance but no history of myocardial infarction or angina pectoris was scheduled for right aortofemoral bypass and thromboembolectomy for arteriosclerosis obliterans with right common iliac and right popliteal arterial thrombus. Epidural anesthesia and general anesthesia were administered without obvious ECG changes. Just after skin incision, ST elevation in leads II and V5 and a short run of ventricular tachycardia with frequent premature ventricular contractions (PVCs) were recorded on the ECG monitor, and the patient's blood pressure suddenly decreased within a few seconds. On noticing these changes, we suspected coronary artery spasm (CAS) and rapidly administered vasodilators and vasopressors to stabilize hemodynamics and ECG changes. Transesophageal echocardiography (TEE) showed basal to mid- and anteroseptal to inferior wall motion hypokinesis that gradually returned to normal during observation. Even in patients without coronary disease but with systemic arteriosclerosis, it is important to consider the possibility of perioperative CAS and not to overlook ECG changes. Immediate diagnosis and treatment are essential. Japanese Society of Anesthesiologists, 2010 Coronary artery spasm nationallicence Vascular disease nationallicence General and epidural anesthesia nationallicence Ito Masaki Department of Anesthesiology, Nagano Matsushiro General Hospital, 183 Matsushiro, Matsushiro town, 381-1231, Nagano, Nagano, Japan aut Hayashi Masachika Department of Anesthesiology, The Cardiovascular Institute Hospital, Tokyo, Japan aut Kagaya Shin Department of Anesthesiology, Saitama Circulation and Respiratory Center, Saitama, Japan aut Kitoh Takeshi Department of Anesthesiology, Nagano Matsushiro General Hospital, 183 Matsushiro, Matsushiro town, 381-1231, Nagano, Nagano, Japan aut Miyoshi Sohtaro Department of Anesthesiology, Saitama Circulation and Respiratory Center, Saitama, Japan aut Journal of Anesthesia Springer Japan 25/1(2011-02-01), 112-116 0913-8668 25:1<112 2011 25 540 https://doi.org/10.1007/s00540-010-1045-8 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00540-010-1045-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ito Masaki Department of Anesthesiology, Nagano Matsushiro General Hospital, 183 Matsushiro, Matsushiro town, 381-1231, Nagano, Nagano, Japan aut NATIONALLICENCE 700 1- Hayashi Masachika Department of Anesthesiology, The Cardiovascular Institute Hospital, Tokyo, Japan aut NATIONALLICENCE 700 1- Kagaya Shin Department of Anesthesiology, Saitama Circulation and Respiratory Center, Saitama, Japan aut NATIONALLICENCE 700 1- Kitoh Takeshi Department of Anesthesiology, Nagano Matsushiro General Hospital, 183 Matsushiro, Matsushiro town, 381-1231, Nagano, Nagano, Japan aut NATIONALLICENCE 700 1- Miyoshi Sohtaro Department of Anesthesiology, Saitama Circulation and Respiratory Center, Saitama, Japan aut NATIONALLICENCE 773 0- Journal of Anesthesia Springer Japan 25/1(2011-02-01), 112-116 0913-8668 25:1<112 2011 25 540 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer