Coronary artery vasospasm during awake deep brain stimulation surgery

Abstract

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.

Deep Brain Stimulation Surgery without Sedation

“…Hypertensive reactions in attacks of anxiety or panic have been described, as well as ischaemic heart attacks [32]. Respiratory distress, limited or disrupted cooperation and hallucinations have been described and listed as indication for general anaesthesia [3].…”

Perioperative Myocardial Infarction in Thoracic Surgery: Awareness, Diagnosis, Follow-up and Treatment

“…Literatüre bakıl-dığında az sayıda rejyonel veya lokal anestezi altında hasta bir rahatsızlık hissinden söz etmiştir (7,8) . Bulgular genellikle hipotansiyon, ritim sorunları gibi belirsizdir ve ST değişikliklerini ameliyat odası koşulların-da yorumlamak güçtür.…”

“…Bulgular genellikle hipotansiyon, ritim sorunları gibi belirsizdir ve ST değişikliklerini ameliyat odası koşulların-da yorumlamak güçtür. Yayınlarda adrenerjik ajanlara (efedrin, metaraminol, adrenalin) bağlı vazospazm ya da doğrudan cerrahi uyaranla oluştuğu gözlenmiştir (7)(8)(9) . Bir olguda ise göz cerrahisi sırasında hiçbir EKG değişikliği olmaksızın PMI oluşmuştur (9) .…”

Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

“…Glossop and Dobbs also report two cases of coronary artery vasospasm during electrode implantation. Though these patients recovered, the authors suggest full monitoring by an anesthesiologist throughout the surgical procedures [69].…”