Anesth Pain Med.  2018 Apr;13(2):180-183. 10.17085/apm.2018.13.2.180.

Coronary artery spasm as the probable cause of cardiac arrest immediately after the induction of spinal anesthesia: A case report

• Kim JA
• Chung CJ
• Yoon KS
• Hong JI
• Lee SC
• Park SY
• Choi SR
• Lee DH
• Jeong JH

• KMID: 2437426
• DOI: http://doi.org/10.17085/apm.2018.13.2.180

Abstract

A 72-year-old man underwent spinal anesthesia for artificial urinary sphincter placement for urinary incontinence. After the block level was confirmed below T6, 1 g of cefotetan, which had not shown any reaction on skin test, was administered as a prophylactic antibiotic. The patient began complaining of chest discomfort and dyspnea shortly after injection. ST elevation appeared on the electrocardiogram and the patient's pulse could not be palpated. Accordingly, cardiopulmonary resuscitation was performed for 5 minutes; the patient recovered spontaneous circulation. The patient was diagnosed as experienced coronary artery spasm by coronary angiography with spasm test. Because coronary artery spasm can also develop in patients with no history of coronary artery disease and under spinal anesthesia, careful observation, suspicion of coronary artery spasm and prompt response to hemodynamic and electrocardiogram changes are necessary.

Keyword

Conduction anesthesia; Coronary vasospasm; Heart arrest; Spinal anesthesia

MeSH Terms

Aged
Anesthesia, Conduction
Anesthesia, Spinal*
Cardiopulmonary Resuscitation
Cefotetan
Coronary Angiography
Coronary Artery Disease
Coronary Vasospasm
Coronary Vessels*
Dyspnea
Electrocardiography
Heart Arrest*
Hemodynamics
Humans
Skin Tests
Spasm*
Thorax
Urinary Incontinence
Urinary Sphincter, Artificial
Cefotetan

Figure

• 

  Fig. 1 (A) Coronary angiography revealing positive spasm test in the mid left anterior descending coronary artery (arrow). (B) Response of the stenotic region to nitroglycerin administration (arrow).

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