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BJA Advance Access originally published online on June 4, 2008
British Journal of Anaesthesia 2008 101(2):222-224; doi:10.1093/bja/aen149
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Coronary artery vasospasm during awake deep brain stimulation surgery

A. Glossop and P. Dobbs*

Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK

* Corresponding author. E-mail: patrick.dobbs{at}sth.nhs.uk

Although vasospasm usually occurs in the presence of normal coronary arteries, its clinical course is indistinguishable from coronary ischaemia, and actual myocardial damage frequently occurs, as demonstrated by ECG changes and troponin rises seen in such cases. Spasm can be promptly and effectively treated if recognized early, and treatment with nitrate therapy is often sufficient to abolish spasm. As patients are awake during deep brain stimulation (DBS) surgery and may be under considerable distress should vasospasm occur, based on the present case report, it is our opinion that in all cases of DBS surgery, full patient monitoring should be mandatory and an anaesthetist should be present throughout the case. Furthermore, if there is a previous history of cardiac disease or vasospasm, the use of 5-lead ECG monitoring and premedication with beta-blockers and nitrates are indicated.

Keywords: anaesthesia, neurosurgical; cardiovascular system, responses; complications, local anaesthetics


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