[Intraoperative coronary spasm in non-cardiac surgery].

BACKGROUND

Cardiovascular events are one of the most critical perioperative complications. The purpose of this study is to investigate the clinical characteristics, effective treatments, and clinical outcome of intraoperative coronary spasm through a review of the published literature.

METHODS

Reports of intraoperative coronary spasm were identified using the Medline database (1977-2000) or by manually searching the Journal of Anesthesia (1987-2000). The clinical characteristics of intraoperative coronary spasm were analyzed in the 56 patients who had developed coronary spasm during non-cardiac surgery.

RESULTS

The mean patient's age was 58 +/- 13 years. The majority of patients were men (75%), Japanese (78%), and had no history of chest pain (75%). Regional anesthesia, vasopressors, alkalosis, hypotension, inadequate depth of anesthesia, and vagal stimulation were noted as major contributing factors. More than half of the patients showed severe hypotension and 30% developed cardiovascular collapse. However, coronary dilators, and nitrates in particular, were very effective for the treatment, and the clinical outcome was relatively good (one death and three cases of myocardial infarction).

CONCLUSIONS

Intraoperative coronary spasm may develop in patients with no history of chest pain. Some of the intraoperative conditions themselves are potent vasoconstricting factors. Once coronary spasm occurs, immediate administration of a full dose of coronary dilators is recommended.