Department of Cardiology, Etlik Ihtisas Education and Research Hospital, Halil Sezai Erkut Caddesi Etlik, Ankara, Turkey.
J Anesth. 2010 Jun;24(3):452-5. doi: 10.1007/s00540-010-0922-5. Epub 2010 Mar 26.
Many cases of coronary artery spasm during regional or general anesthesia have been reported. To our knowledge, for the first time we report a case of coronary artery spasm induced by general anesthesia that was documented by immediate angiography and treated with intracoronary nitroglycerine. A 68-year-old female was to undergo elective cholecystectomy. General anesthesia was induced by propofol 140 mg, fentanyl 50 microg, and vecuronium bromide 7 mg. Immediately after intubation sudden hypotension (60/40 mmHg) and marked ST-segment elevation on the monitor were noticed. A 12-lead electrocardiogram demonstrated marked ST-segment elevations in inferior leads with reciprocal changes. An immediate diagnostic coronary angiography showed diffuse severe narrowing of the right coronary artery with a non-critical plaque in the midportion. After intracoronary administration of nitroglycerine 0.2 mg into the right coronary artery, there was marked diffuse vasodilatation. A diagnosis of variant angina was made and 2 days of hospital course was uneventful. The patient was discharged taking diltiazem 120 mg two times daily, aspirin 100 mg daily and isosorbidemononitrate 60 mg daily.
许多病例的冠状动脉痉挛在区域或全身麻醉期间已经报道。据我们所知，这是首次报告一例冠状动脉痉挛全身麻醉引起的记录，立即血管造影和治疗用冠状动脉内硝酸甘油。一个 68 岁的女性进行择期胆囊切除术。全身麻醉诱导异丙酚 140 毫克，芬太尼 50 微克，和维库溴铵 7 毫克。在插管后立即出现低血压（60/40 毫米汞柱）和监测器上的显著 ST 段抬高。十二导联心电图显示在下方导联有明显的 ST 段抬高，伴有对应导联的 ST 段压低。立即进行冠状动脉造影显示右冠状动脉弥漫性严重狭窄，中段有非关键斑块。在右冠状动脉内给予硝酸甘油 0.2 毫克后，出现广泛的血管扩张。诊断为变异型心绞痛，住院 2 天无并发症。患者出院时服用地尔硫卓 120 毫克，每日两次，阿司匹林 100 毫克，每日硝酸异山梨酯 60 毫克。
