Chang Kyung-ho, Obara Mizuki, Ogawa Makoto, Chinzei Mieko, Hanaoka Kazuo
Department of Anesthesiology, Faculty of Medicine, University of Tokyo, Tokyo 113-8655.
Masui. 2004 Jan;53(1):48-54.
We report three cases of intraoperative coronary spasm that developed during non-cardiac surgical procedures. None of the patients had a history of anginal chest pain. The presumed contributing factors were: 1) suction of the trachea during general anesthesia, 2) hyperventilation and hypotension during induction of general anesthesia, and 3) hyperventilation during neuroanesthesia. Coronary vasodilators were administered and all cases recovered promptly without any clinical sequelae. A review of the literature reveals that the majority of patients who developed intraoperative coronary spasm had no history of anginal chest pain. Some of common intraoperative conditions such as hyperventilation, hypotension, and inadequate depth of anesthesia, were reported to be potent precipitating factors for coronary spasm. In recent years, a larger proportion of surgical patients have coronary risk factors. Careful anesthetic management is required to prevent intraoperative coronary spasm even in patients without a history of coronary artery disease.
我们报告了3例在非心脏外科手术过程中发生的术中冠状动脉痉挛病例。所有患者均无心绞痛病史。推测的促成因素有：1）全身麻醉期间气管吸引；2）全身麻醉诱导期间过度通气和低血压；3）神经麻醉期间过度通气。给予冠状动脉扩张剂后，所有病例均迅速康复，无任何临床后遗症。文献回顾显示，发生术中冠状动脉痉挛的大多数患者无心绞痛病史。据报道，一些常见的术中情况，如过度通气、低血压和麻醉深度不足，是冠状动脉痉挛的强效诱发因素。近年来，有冠状动脉危险因素的外科手术患者比例更大。即使对于无冠状动脉疾病病史的患者，也需要谨慎的麻醉管理以预防术中冠状动脉痉挛。
