Coronary vasospasm during anesthesia induction: awareness, recognition, possible mechanisms, anesthetic factors, and treatment

We describe a patient who developed severe ST-segment elevation, pulseless ventricular tachycardia, and cardiac arrest during induction of general anesthesia. This transient ST-segment elevation may have been the result of coronary artery spasm. Awareness of this variant of coronary artery vasospasm—Prinzmetal angina—in patients without clear symptoms or established ischemic heart disease, is the key to successful outcome. Recommended preparations and treatments are preoperative calcium channel blockers, nitroglycerin available intraoperatively, reduction of endogenous or exogenous catecholamines, and vigilant monitoring.