O-uchi Jin, Komukai Kimiaki, Tohyama Jun-ichiro, Inada Keiichi, Iwano Keiji, Yamane Teiichi, Shibata Takahiro, Mochizuki Seibu
Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Jpn Heart J. 2003 Nov;44(6):1021-6. doi: 10.1536/jhj.44.1021.
We thoroughly examined a 26-year-old Japanese male who experienced perioperative ventricular tachycardia. After inhaling sevoflurane, his nasal cavity was soaked with 1:100,000 epinephrine and he was intubated through the nose. Junctional tachycardia occurred five minutes after intubation, changing to ventricular tachycardia. Six-time cardioversion was required to stop the ventricular tachycardia. Echocardiography immediately following the event showed diffuse hypokinesis, and an electrocardiogram showed an inversion of T waves in II, III, aVF and V4-6. Both returned to normal within a few days. Tl scintigraphy revealed a normal perfusion image. Coronary angiography showed a normal coronary, but an injection of acetylcholine induced vasospasm in the right coronary artery. Examination of left ventricular tissue yielded no specific findings. During electrophysiological tests, ventricular tachycardia could not be induced even in the presence of isoprenaline. This is a very young case to elicit vasospasm in the coronary artery with no underlying heart disease. Although the relationship between perioperative ventricular tachycardia and coronary spasm is unknown, cardiac events can occur during anesthesia in young and low-risk patients.
我们对一名26岁经历围手术期室性心动过速的日本男性进行了全面检查。吸入七氟醚后，其鼻腔用1:100,000肾上腺素浸润，然后经鼻插管。插管后五分钟出现交界性心动过速，随后转变为室性心动过速。为终止室性心动过速需要进行六次心脏复律。事件发生后立即进行的超声心动图显示弥漫性运动减弱，心电图显示II、III、aVF及V4 - 6导联T波倒置。两者在数天内均恢复正常。铊闪烁扫描显示灌注图像正常。冠状动脉造影显示冠状动脉正常，但注射乙酰胆碱可诱发右冠状动脉痉挛。左心室组织检查未发现特异性结果。在电生理检查中，即使使用异丙肾上腺素也无法诱发室性心动过速。这是一例非常年轻且无潜在心脏病却引发冠状动脉痉挛的病例。尽管围手术期室性心动过速与冠状动脉痉挛之间的关系尚不清楚，但在年轻及低风险患者的麻醉过程中可能会发生心脏事件。
