Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan.
Anesth Prog. 2022 Sep 1;69(3):20-24. doi: 10.2344/anpr-69-01-02.
This is a case report of an 81-year-old woman who underwent tracheostomy, bilateral cervical dissection, partial tongue resection, radial forearm free flap reconstruction, and split-thickness skin grafting under general anesthesia. After successful surgery, she was moderately sedated postoperatively with intravenous dexmedetomidine (DEX) and fentanyl. The fentanyl was discontinued 5 hours postoperatively. Eight hours after the operation, an atrioventricular junctional rhythm, a 2-mm elevation of the ST segment, and biphasic T waves were detected in lead II that lasted approximately 3 minutes. Hypotension and bradycardia were observed simultaneously with the abnormal electrocardiogram. The next day, a cardiologist examined the patient and suggested that coronary spasm had occurred based on those findings. The transient coronary spasm was likely caused by a combination of various factors including surgical stress and altered autonomic function. However, it is possible that stimulation of α-2 adrenergic receptors induced by DEX may also be linked to the coronary vasospasm that occurred.
这是一例 81 岁女性患者的病例报告，她在全麻下行气管切开术、双侧颈清扫术、部分舌切除术、游离前臂桡侧皮瓣重建术和中厚皮片植皮术。手术成功后，患者术后给予静脉注射右美托咪定（DEX）和芬太尼中度镇静。术后 5 小时停用芬太尼。术后 8 小时，在 II 导联中检测到房室结节律、ST 段抬高 2mm 和双向 T 波，持续约 3 分钟。同时观察到低血压和心动过缓。第二天，心脏病专家检查了患者，并根据这些发现建议发生了冠状动脉痉挛。短暂性冠状动脉痉挛可能是由手术应激和自主神经功能改变等多种因素共同引起的。然而，DEX 诱导的α-2 肾上腺素能受体刺激也可能与发生的冠状动脉血管痉挛有关。
