Ishiyama T, Murakami N, Takeda T, Shimonaka H, Dohi S
Department of Anesthesia, Gifu City Hospital.
Masui. 1991 Dec;40(12):1863-8.
A 57-year-old man without any history of coronary artery disease underwent total hip replacement for which a continuous lumbar epidural analgesia combined with general anesthesia was used. During the recovery from anesthesia, the patient developed sudden hypotension and ventricular fibrillation (Vf), followed by ST elevation (I, II, III, aVF and V2-V6) on ECG. A coronary angiography, which was performed 30 min after the onset of Vf, revealed both the total occlusion of proximal left anterior descending artery (LAD) and 25% stenosis of proximal right coronary artery. It seemed that coronary artery spasm had occurred during the emergence from anesthesia, and then the coronary spasm ceased in a minute or two, while thrombus was produced in proximal LAD. The patient recovered from the episode of myocardial ischemia after percutaneous transluminal coronary recanalization and intraaortic balloon pumping. This patient was operated again on 4th and 8th postoperative days uneventfully under general anesthesia (enflurane and nitrous oxide in oxygen).
一名57岁无冠心病病史的男性接受了全髋关节置换术，术中采用连续腰段硬膜外镇痛联合全身麻醉。麻醉恢复期间，患者突然出现低血压和心室颤动（室颤），随后心电图显示ST段抬高（I、II、III、aVF及V2-V6导联）。室颤发作30分钟后进行的冠状动脉造影显示，左前降支近端完全闭塞，右冠状动脉近端狭窄25%。似乎在麻醉苏醒过程中发生了冠状动脉痉挛，随后冠状动脉痉挛在一两分钟内停止，而左前降支近端形成了血栓。经皮冠状动脉腔内再通术和主动脉内球囊反搏术后，患者从心肌缺血发作中恢复。该患者在术后第4天和第8天再次接受全身麻醉（安氟醚和笑气-氧气混合气）手术，过程顺利。
