Coronary Artery Spasm during Epidural Plus General Anesthesia

XiVe present a case o£ coronary artery spasm during epidural plus general anesthesia. A 7i-year-old man was scheduled for pancreatoduodenectomy. A continuous thoracic epiclurai block was performed at the Th IO-ll interspace and gei}eral anesthesia was maintained with enfiurane and nitrous oxide in oxygen. Thirty minutes after the start of the operatioil, hypotension occurred suddenly and the ECG showe(l elevation of the ST segment, widening of the QRS complex and occasional velttricular premature beats. These changes resolved abruptiy without treatment. The same episodes occurrecl both 1 hour and 30 min before the end of the operation, and were considered to be catised by coronary artery spasm. We used a continuous nitroglycerin infusion to prevent the coronary vasospasm. No fttrther episodes of the coronary vasospasm occurrecl. It is uncertain that the coroRary spasms in this patient were clue to the hyperventilation or epidural anesthesia.