Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000600013
Brazilian Journal of Anesthesiology
Clinical Information

Parada cardíaca súbita em anestesia geral como a primeira manifestação da origem anômala de artéria coronária esquerda

Sudden cardiac arrest in general anesthesia as the first manifestation of anomalous origin of the left coronary artery

Maurício Daher; André Rodrigues Zanatta; Benhur David Henz; Marcelo Carneiro da Silva; Simone Nascimento dos Santos; Luiz Roberto Leite

http://dx.doi.org/10.1590/S0034-70942012000600013 Braz J Anesthesiol, vol.62, n6, p.881-884, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: O relato de caso descreve uma situação rara e potencialmente fatal associada à administração de anestesia. Nosso objetivo foi discutir as causas de parada cardíaca súbita no período perioperatório em pacientes aparentemente saudáveis e a fisiopatologia das anomalias de origem das artérias coronárias como uma causa de parada cardíaca súbita. RELATO DE CASO: Uma mulher de 44 anos, sem sintomas prévios de doença coronariana ou arritmias, apresenta parada cardíaca súbita durante a instalação de anestesia geral em duas situações distintas. No primeiro episódio, a paciente apresentava-se com quadro de abdômen agudo, porém hemodinamicamente estável. Após a indução anestésica, ocorreu bradicardia e hipotensão arterial, refratárias à reposição de volume e vasopressores. O quadro evoluiu para assistolia. A paciente foi reanimada com sucesso e recebeu alta em boas condições. No segundo episódio, um ano após o primeiro, a paciente se encontrava em boas condições clínicas para feitura de uma cirurgia eletiva. Após a indução anestésica, a paciente desenvolveu taquicardia ventricular seguida por assistolia, que foi prontamente revertida. Após extensa investigação, foi identificada uma origem anômala da artéria coronária esquerda. CONCLUSÕES: Nosso relato é ilustrativo ao enfatizar que uma investigação diagnóstica minuciosa deve ser feita nos casos de parada cardíaca súbita perioperatória, mesmo em pacientes aparentemente saudáveis.

Palavras-chave

ANATOMIA, ANESTESIA, Geral, COMPLICAÇÕES, Parada cardiorrespiratória, Morte Súbita, Vasos Coronários

Abstract

BACKGROUND AND OBJECTIVES: This case report describes a rare and potentially fatal condition associated with anesthesia administration. Our aim was to discuss the causes of sudden cardiac arrest during the perioperative period in apparently healthy patients and the pathophysiology of anomalous origin of the coronary arteries as a cause of sudden cardiac arrest. CASE REPORT: Female patient, 44 years old, with no previous symptoms of heart disease or arrhythmias, had a sudden cardiac arrest during general anesthesia in two different situations. In the first episode, the patient presented signs of acute abdomen, but remained hemodynamically stable. Following induction of anesthesia, the patient exhibited bradycardia and hypotension refractory to volume replacement and vasopressors. The condition progressed to asystole. The patient was successfully resuscitated and discharged from the hospital in good condition. In the second episode, one year after the first, the patient was in good clinical condition to undergo an elective surgery. After induction of anesthesia, the patient developed ventricular tachycardia followed by asystole, which was promptly reversed. After extensive investigation, an anomalous origin of the left coronary artery was identified. CONCLUSIONS: Our report is illustrative as it emphasizes that a thorough diagnostic investigation should be done in cases of sudden cardiac arrest during the perioperative period, even in patients that appear to be healthy.

Keywords

Anesthesia, Coronary Vessel Anomalies, Death, Sudden, Cardiac, Heart Arrest

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