CARDIAC-ARREST CAUSED BY CORONARY SPASM IN 2 PATIENTS DURING RECOVERYFROM EPIDURAL-ANESTHESIA

Background and Objectives. In order to reduce the surgical stress on t he heart, anesthesiologists frequently use regional anesthesia in pati ents with coronary artery disease. Methods. Two patients underwent rec onstructive peripheral vascular surgery under continuous epidural anes thesia with bupivacaine. During the surgery and later in the recovery room, they received continuous electrocardiographic (EGG), invasive ar terial blood pressure, and oxyhemoglobin saturation monitoring. Result s. In both patients, the anesthetic course during surgery was uneventf ul, but while recovering from the anesthesia, they developed ECG chang es consistent with myocardial ischemia, followed by malignant dysrhyth mias and cardiac arrest. The clinical pictures, ECGs, coronary angiogr am, and (in one patient) autopsy findings suggested coronary artery sp asm as the cause of the malignant dysrhythmias and cardiac arrests. Co nclusions. It is possible that the coronary spasms were caused by an a ltered balance between sympathetic and parasympathetic nervous activit y during recovery from epidural anesthesia. Therefore, patients with c oronary artery disease must be closely monitored for signs and symptom s of myocardial ischemia during the entire recovery period from epidur al anesthesia.