[Coronary Artery Spasm during Anesthesia: Discussion of Cases Leading to Circulatory Collapse through 51 Reports of the Published Literature].

Background: Perioperative coronary artery spasm (GAS) is one of the serious complications leading to circulatory collapse. Here we retrospectively examined the impact of CAS and discussed its prevention strate- gies.

Methods: Reports of intraoperative CAS were iden- tified by using the PubMed and by manually searching the Journal of Japan Society for Clinical Anesthesia (2001-2015). Analyses were performed on 51 patients who developed CAS and had had no history of isch- emic heart disease.

Results: Of the 51 analyzed patients, 19 developed circulatory collapse. In these patients, the rate of early administration of a sufficient dose of a coronary vasodi- lator was low, and they tended to have prolonged and/ or recurrent attacks. Among them, two patients may have had a problem due to the dosage and/or admin- istration method for coronary vasodilator, despite early administration. In addition, we found that a combina- tion of general anesthesia and epidural block may have contributed to the collapse. In three cases, it was diffi- cult to identify the predictors of circulatory collapse.

Conclusions: Awareness of CAS and vigilant moni- toring are crucial for preventing circulatory collapse. When a transient ST-segment change indicates possi- ble CAS, adequate dosages of a coronary vasodilator should be promptly administered.