Anesthesia Management of a Patient with a History of Cardiac Arrest during Two Operations

Abstract

A 55-year-old man was resuscitated from ventricular fibrillation during two previous general anesthesia procedures. We performed open reduction and internal fixation followed by removal of a bony foreign body for right ulnar olecranon fracture under general anesthesia. Preoperative evaluation revealed possible long QT syndrome on electrocardiogram and vasospastic angina on cardiac catheterization with three positive branches on acetylcholine stress test. General anesthesia was induced with propofol, fentanyl, and rocuronium, followed by supraclavicular brachial plexus block and maintenance with propofol and remifentanil without inhaled anesthetics. Nicorandil was infused perioperatively to prevent coronary spasm, PaCO₂ was maintained at 39-43 mmHg, and systolic blood pressure was maintained above 100 mmHg perioperatively. The patient was discharged on schedule without experiencing any major complications. Our perioperative management may have reduced the risk of ventricular fibrillation caused by vasospastic angina or long QT syndrome.