Coronary Spasm During Postoperative Sedation With Dexmedetomidine
This is a case report of an 81-year-old woman who underwent tracheostomy, bilateral cervical dissection, partial tongue resection, radial forearm free flap reconstruction, and split-thickness skin grafting under general anesthesia. After successful surgery, she was moderately sedated postoperatively with intravenous dexmedetomidine (DEX) and fentanyl. The fentanyl was discontinued 5 hours postoperatively. Eight hours after the operation, an atrioventricular junctional rhythm, a 2-mm elevation of the ST segment, and biphasic T waves were detected in lead II that lasted approximately 3 minutes. Hypotension and bradycardia were observed simultaneously with the abnormal electrocardiogram. The next day, a cardiologist examined the patient and suggested that coronary spasm had occurred based on those findings. The transient coronary spasm was likely caused by a combination of various factors including surgical stress and altered autonomic function. However, it is possible that stimulation of α-2 adrenergic receptors induced by DEX may also be linked to the coronary vasospasm that occurred.
Preoperative 12-lead ECG. The patient's routine preoperative 12-lead ECG demonstrated severe sinus bradycardia (rate ∼35 bpm) and voltage criteria consistent with left ventricular hypertrophy.
Postop transient coronary spasm. While sedated 8 hours postoperatively with DEX, an AV junctional rhythm, 2 mm ST elevation, and biphasic T waves were detected in lead II, which lasted for 3 minutes before returning to normal sinus rhythm.
Repeat 12-lead ECG 3 months later. Another 12-lead ECG performed 3 months later demonstrated bradycardia (rate ∼37 bpm), an AV junctional rhythm, but no ST segment abnormalities.
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