Myocardial Infarction in Non-obstructive Coronary Arteries (MINOCA) in the Perioperative Period can Epinephrine be Responsible?

Ephedrine, metaraminol, epinephrine and maneuvers like carotid sinus stimulation used during intraoperative period have been postulated to cause temporary spasm of the coronary vessels leading decrease supply myocardium precipitating myocardial infraction in non-obstructive arteries (MINOCA). As an anaesthesiologists, we should be aware that even a dose as small 25 mcg infiltrated along with local anaesthetic subcutaneous plane may responsible for vessel thus nonobstructive arteries.
 We report case 45 years old female papillary carcinoma thyroid who developed features non-ST elevation infarction 5 minutes after infiltration ml 2% Xylocaine 1:200000 Epinephrine. Patient was managed acute Myocardial Infarction. Coronary angiogram done next day revealed normal arteries, hence diagnosis made.