2018 Volume 38 Issue 2 Pages 142-147
We experienced a case of cardiac arrest due to coronary artery spasm on extubation after thymectomy. The patient was a 60-year-old male. He had several risk factors of coronary vasospasm including being a male, a smoker and a drinker in addition to abnormal of lipid metabolism, but he did not have any significant coronary abnormalities preoperatively. He underwent thymectomy under veno-venous bypass for hemodynamic instability, which required frequent administration of phenylephrine. Cardiac arrest occurred following hypotension and ST elevation on an electrocardiogram（ECG）after surgery. His spontaneous circulation recovered 2 minutes after cardiopulmonary resuscitation. There was cardiac dysfunction indicating anteroseptal abnormal wall motion on the ECG. The ECG change was transient and was resolved without any invasive intervention within several days after surgery. He was finally discharged from the hospital without any disabilities. Coronary artery spasm was strongly suspected as a cause of the cardiac arrest because of the positive result of a provocation test for coronary spasm after surgery. In addition to preoperative risk factors for coronary spasm, several intraoperative factors, including surgical invasiveness, situation of awakening and administration of an anesthesia-related agent, possibly led to coronary spasm.
