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.
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Fall 2022
CASE REPORTS|
October 06 2022
Coronary Spasm During Postoperative Sedation With Dexmedetomidine
Yu Sato, DDS, PhD;
Yu Sato, DDS, PhD
Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan
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Tomoka Matsumura, DDS, PhD;
Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan
Address correspondence to Tomoka Matsumura, Tokyo Medical and Dental University, Dental Hospital 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan; tomoanph@tmd.ac.jp.
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Yushi Abe, DDS;
Yushi Abe, DDS
Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan
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Chihiro Kutsumizu, DDS;
Chihiro Kutsumizu, DDS
Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan
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Shigeru Maeda, DDS, PhD
Shigeru Maeda, DDS, PhD
Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan
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Anesth Prog (2022) 69 (3): 20–24.
Article history
Received:
April 21 2021
Accepted:
December 14 2021
Citation
Yu Sato, Tomoka Matsumura, Yushi Abe, Chihiro Kutsumizu, Shigeru Maeda; Coronary Spasm During Postoperative Sedation With Dexmedetomidine. Anesth Prog 1 September 2022; 69 (3): 20–24. doi: https://doi.org/10.2344/anpr-69-01-02
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