Koshiba K, Hoka S
Department of Anesthesiology, Kitasato University, School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228, Japan.
J Anesth. 2001;15(2):93-9. doi: 10.1007/s005400170034.
Factors affecting perioperative development of coronary spasm have not been elucidated. A number of case reports describing perioperative coronary spasm have appeared in Japanese anesthesia journals, mostly published in Japanese. The purpose of this study was to investigate the contributing factors affecting perioperative coronary artery spasm by reviewing the published articles.
Reports were identified by using Medline database (1968-1998) or by manually searching nonindexed Japanese journals. The clinical characteristics of perioperative coronary spasm were analyzed in 115 patients who developed coronary artery spasm during the perioperative period.
The mean age of the patients was 64 +/- 9 years (range, 36 to 87 years). There were 97 men (84%) and 18 women (16%). Preoperative risk factors included hypertension (27%), angina pectoris (27%), cigarette smoking (13%), and diabetes mellitus (11%). The attack was related to inadequate depth of general anesthesia (23%), use of vasopressors (22%), vagal reflex (19%), administration of drugs other than vasopressors (17%), and epidural block (15%). About 85% of patients showed no ischemic abnormality on the preoperative electrocardiogram, whereas 56% had significant coronary stenosis on postoperative coronary arteriography. Coronary spasm tended to occur in patients under inhalation anesthesia combined with epidural block. Nitrates alleviated the episode in the majority of cases, whereas defibrillation and cardiac massage were required in 19% of patients. No deaths were reported.
Perioperative coronary spasm is prevalent in elderly male patients with coronary risk factors who undergo abdominal or thoracic surgery under inhalational anesthesia combined with epidural anesthesia. Instability of the autonomic nervous system and/or vascular hyperreactivity may be the underlying pathogenic mechanisms of perioperative coronary spasm.
围手术期冠状动脉痉挛发生发展的影响因素尚未阐明。一些描述围手术期冠状动脉痉挛的病例报告已发表在日本麻醉学杂志上，大多以日语发表。本研究的目的是通过回顾已发表的文章来调查影响围手术期冠状动脉痉挛的相关因素。
通过使用Medline数据库（1968 - 1998年）或手动检索未被索引的日语期刊来识别相关报告。对115例在围手术期发生冠状动脉痉挛的患者的临床特征进行了分析。
患者的平均年龄为64±9岁（范围为36至87岁）。男性97例（84%），女性18例（16%）。术前危险因素包括高血压（27%）、心绞痛（27%）、吸烟（13%）和糖尿病（11%）。发作与全身麻醉深度不足（23%）、血管升压药的使用（22%）、迷走神经反射（19%）、血管升压药以外药物的使用（17%）和硬膜外阻滞（15%）有关。约85%的患者术前心电图无缺血异常，而56%的患者术后冠状动脉造影显示有明显冠状动脉狭窄。冠状动脉痉挛倾向于发生在吸入麻醉联合硬膜外阻滞的患者中。大多数情况下硝酸酯类药物可缓解发作，而19%的患者需要除颤和心脏按摩。未报告死亡病例。
围手术期冠状动脉痉挛在有冠状动脉危险因素的老年男性患者中较为普遍，这些患者在吸入麻醉联合硬膜外麻醉下接受腹部或胸部手术。自主神经系统的不稳定和/或血管高反应性可能是围手术期冠状动脉痉挛的潜在发病机制。
