Tatara T, Kuroda T, Miyao H, Kawasaki J, Shigematsu T, Kawazoe T
Department of Anaesthesiology, Saitama Medical Center, Saitama Medical School, Kawagoe.
Masui. 1990 Jan;39(1):99-105.
A 63-yr-old man weighing 56kg was scheduled for pharyngoplasty under general anesthesia. The patient had no history of ischemic heart disease. Preoperative ECG showed incomplete right branch block. We administered thiopental and succinylcholine for intubation. Anesthesia was maintained with enflurane, nitrous oxide, oxygen and pancuronium bromide. Thirty minutes after the start of incision, the patient developed a severe hypotension and ECG revealed ST elevation and complete AV block. We administered ephedrine hydrochloride, phenylephrine hydrochloride and atropine sulfate. The ECG returned to sinus rhythm but ST segment was depressed this time. We considered it due to coronary spasm, so we started continuous intravenous administration of nitroglycerin (0.5 microgram. kg-1. min-1). One hour later, ST segment returned to normal. ECG showed no remarkable changes and no symptoms were seen after the operation. We found it important to suspect coronary spasm when ECG showed PVC-like abnormal waves with ST elevation. We consider that continuous administration of nitroglycerin at a rate of 0.5 microgram. kg-1. min-1 was effective for the treatment of coronary spasm in this case.
一名63岁、体重56公斤的男性计划在全身麻醉下进行咽成形术。该患者无缺血性心脏病史。术前心电图显示不完全性右束支传导阻滞。我们给予硫喷妥钠和琥珀酰胆碱进行插管。麻醉维持采用恩氟烷、氧化亚氮、氧气和泮库溴铵。手术切口开始30分钟后，患者出现严重低血压，心电图显示ST段抬高和完全性房室传导阻滞。我们给予盐酸麻黄碱、盐酸去氧肾上腺素和硫酸阿托品。心电图恢复为窦性心律，但此时ST段压低。我们认为这是由于冠状动脉痉挛所致，因此开始持续静脉输注硝酸甘油（0.5微克·千克-1·分钟-1）。1小时后，ST段恢复正常。术后心电图无明显变化，也未出现症状。我们发现，当心电图显示类似室性早搏的异常波伴ST段抬高时，怀疑冠状动脉痉挛很重要。我们认为，在该病例中，以0.5微克·千克-1·分钟-1的速率持续输注硝酸甘油对治疗冠状动脉痉挛有效。
