A Case Report of Intraoperative Ventricular Tachycardia and Postoperative Sudden Death

Abstract

A 72-year-old male with no preoperative medical problems underwent cervical laminoplasty. Anesthesia was induced with thiopental, fentanyl and vecuronium, and maintained with fentanyl and a mixture of O₂-N₂O and sevoflurane. Hypotension occurred when he was in the prone position, but his blood pressure was soon recovered. His intraoperative blood pressure was about 100/60 mmHg and heart rate was about 100min-1. Suddenly, the ECG monitor demonstrated R on T followed by shortrun and ventricular tachycardia. Lidocaine, dopamine and ephedrine were administerd intravenously, and the surgery was terminated. The results of the analysis of his blood gas, electrolytes, enzymes from the myocardium, echocardiogram and EGG were within normal limits.
Although there was no ventricular arrhythmia during the postoperative period, he died from sudden cardiac arrest ten days postoperatively. The autopsy showed myocardial infarction, thrombus with intimal injury in the coronary artery lumen and inflammatory cell infiltration in the epicardium. However, coronary artery stenosis was not significant.
These findings suggest that intraoperative ventricular tachycardia is induced by a coronary spasm, which may be caused by hypotension, the use of ephedrine or inadequate depth of anesthesia.