Coronary Artery Spasm Induced by Dopamine Infusion in a Hypertensive Patient during Anesthesia

Abstract

A 72-year-old male with prostatic cancer was scheduled for total prostatectomy. He had a past history of hypertension without symptoms of angina pectoris. Nffedipine had been given for one year.
Anesthesia was maintained with sevoflurane-N₂O-vecuronium. When systolic blood pressure decreased to 80mm Hg, we separately administered three vasopressors: ethyl-phenylephrine, phenylephrine and dopamine. The administration of 1mg of ethylphenyle-phrine or 0.2mg of pheylephrine increased blood pressure without elevation of ST segment. However, 3 min after administration of dopamine at the rate of 10μg•kg^-1•min^-1, ST segment was elevated and systolic blood pressure decreased to 60mm Hg. The patient was diagnosed as coronary vasospasm by coronary arteriography after the operation.
Dopamine may be more likely to induce coronary spasm than other vasopressors (ethyl-phenylephrine, phenylephrine) in patients with variant angina. It should therefore be administered cautiously in patients with variant angina, especially in hypertensive patients who have been given nifedipine, because such patients often have an asymptomatic variant angina.