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Korean Journal of Anesthesiology 2008;54(3):343-346.
DOI: https://doi.org/10.4097/kjae.2008.54.3.343   
Severe Hypotension Caused by Coronary Spasm during Recovery from Combined Spinal Epidural Anesthesia: A case report.
Bum Sang Hwang, Min soo Kim, Seong Sik Kang, Byeong Moon Hwang, Hee Jeong Son, Il Young Cheong
Department of Anesthesiology and Pain Medicine, Kangwon National University Medical School, Chuncheon, Korea. sskang@kangwon.ac.kr
In order that anesthesiologists may reduce the anesthetic and surgical stress on the heart, they frequently use regional anesthesia in patients with coronary artery disease, even though there is no evidence that it reduce the incidence of myocardial ischemia. We report a case of life-threatening cardiovascular collapse that occurred in a 47 years old male patient at the emergence from regional anesthesia. He underwent open reduction and internal fixation for femur fracture under combined spinal epidural anesthesia.The cause of serious hypotension is suspected of myocardial ischemia on the basis of ST segment elevation on EKG. We considered that these cardiovascular events were due to coronary spasm.The possible inducing factors of coronary spasm were altered autonomic balance and arteriosclerotic change related endothelial dysfunction.
Key Words: coronary spasm; myocardial ischemia; regional anesthesia


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