Coronary Arterial Spasm Induced by Vagovagal Reflex under Continuous Infusion of NTG and DTZ during General Anesthesias

Abstract

A 68-year old male with recurrent gastric cancer was scheduled for total gastrectomy. Coronary spastic angina was diagnosed by ergonopine test preoperatively.
Before induction of anesthesia, we started continuous infusion of NTG (0.3μg/kg/min) and DTZ (0.8μg/kg/min), and general anesthesia was maintained with GOF.
When stomach was retracted, blood pressure declined from 150/85 mmHg to 100/50 mmHg and bradycardia of 50/min occurred. Atropine sulfate 0.5mg was injected and the concentration of halothane and infusion rate of DTZ were decreased. Blood pressure and heart rate gradually recovered. At this point, however, ST segment was elevated.
After bolus injection of 0.5mg NTG, the elevated ST segment returned to normal. Coronary arterial spasm was induced by vagovagal reflex due to gastric traction, and it was alleviated by NTG.
It seems that the continuous infusion rate of TNG and DTZ used was not sufficient to prevent coronary arterial spasm.
A higher continuous infusion rate of NTG and DTZ might have prevented coronary arterial spasm in this case.