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Korean Journal of Anesthesiology 2008;54(1):84-87.
DOI: https://doi.org/10.4097/kjae.2008.54.1.84   
Acute Myocardial Infarction during General Anesthesia Combined with Epidural Anesthesia: A case report.
Jin Hun Chung, Yong Han Seo, Ki Ryang Ahn, Chun Sook Kim, Kyu Sik Kang, Sie Hyun You, Ji Weon Chung
Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea. schanesth@lycos.co.kr
The general anesthesia combined with epidural anesthesia have many advantages, which are including early recovery, postoperative analgesia, and less requirement of inhalation anesthetic. But the complications of epidural anesthesia such as total spinal anesthesia, respiratory depression, myocardial ischemia, and local anesthetic toxicity can lead to cardiac arrest. We report a case of acute myocardial infarction in a 74-year-old female patient receiving general anesthesia combined with epidural anesthesia. The profound hypotension without bradycardia and ST-segment elevation in lead II occurred 1 hour after local anesthetic injection and cardiac arrest followed. After the injection of atropine, epinephrine and dopamine, and external cardiac massage, sinus rhythm was restored. Postoperative serial examinations of ECG showed ST-segment elevation in leads II, III, aVF and serum enzymes such as CPK, CK-MB, and Troponin T were elevated. Emergency percutaneous transluminal coronary angioplasty was performed and the patient recovered uneventfully.
Key Words: acute myocardial infarction; cardiac arrest; epidural anesthesia


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