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Pathogenesis and treatment for anesthesia-related coronary arterial spasm

Research Project

Project/Area Number 09470329
Research Category

Grant-in-Aid for Scientific Research (B)

Allocation TypeSingle-year Grants
Section一般
Research Field Anesthesiology/Resuscitation studies
Research InstitutionKITASATO UNIVERSITY

Principal Investigator

HOKA Sumio  Kitasato Univ.School of Medicine, Professor, 医学部, 教授 (60150447)

Co-Investigator(Kenkyū-buntansha) TAKENAKA Tomoaki  Kitasato Univ.School of Medicine, Assistant Professor, 医学部, 講師 (00179657)
YAMAURA Ken  Kyushu Univ.School of Medicine, Research Associate, 医学部, 助手 (70264041)
KAWASAKI Toshihiro  Kitasato Univ.School of Medicine, Research Associate, 医学部, 助手 (80253433)
SHIMOKAWA Hiroaki  Kyushu Univ.School of Medicine, Associate Professor, 医学部, 助教授 (00235681)
Project Period (FY) 1997 – 1999
Project Status Completed (Fiscal Year 1999)
Budget Amount *help
¥10,500,000 (Direct Cost: ¥10,500,000)
Fiscal Year 1999: ¥1,400,000 (Direct Cost: ¥1,400,000)
Fiscal Year 1998: ¥2,400,000 (Direct Cost: ¥2,400,000)
Fiscal Year 1997: ¥6,700,000 (Direct Cost: ¥6,700,000)
Keywordscoronany spasm / perioperative / anesthesia / epidural block / vasopressors / risk factor / nitroglycerin / 手術 / 交感神経 / プロポフォール / 麻酔薬
Research Abstract

The incidence of coronary arterial spasm is considered to be relatively high among Japanese compared to Caucasians (1), although the morbidity and mortality of coronary arterial disease are much lower in Japanese (2). A number of case reports of perioperative coronary artery spasm have been published in non-indexed Japanese anesthetic journals, and were to a large extent authored by Japanese. The individual reports show relatively small numbers of patients with specific conditions and treatment regimens, making it difficult to clearly define which factors affect perioperative coronary artery spasm. The purpose of this study is to investigate the contributing factors affecting perioperative coronary artery spasm by reviewing the published articles. Methods : Reports of the perioperative coronary artery spasm were identified by searching the Medline (1968-1998), and Japanese journals (1980-1998). The selected criteria for perioperative coronary artery spasm included ischemic electrocardi … More ographic changes as demonstrated typically by ST segment elevation without preceding remarkable changes in determinants of myocardial demand or supply, and the incidence occurred after arrival in the operating room before, during or following general and/or regional anesthesia. Results : The clinical characteristics of perioperative coronary spasm were analyzed in 115 patients. Mean age of patients was 64 years (range, 36 to 87 years). There were 97 men (84%) and 18 women (16%). Preoperative risk factors included hypertension (27%), angina pectoris (27%), cigarette smoking (13%) and diabetes mellitus (11%). The attack was related to inadequate depth of general anesthesia (23%), use of vasopressors (22%), vagal reflex (19%), administration of drugs other than vasopressors (17%) and epidural block (15%). Drugs other than vasopressors as possible causes included prostaglandin E1, vecuronuim, doxapram, and trimethaphan. About 85% of patients showed no ischemic abnormality on the preoperative electrocardiogram, while 56% had significant coronary stenosis on postoperative coronary arteriography. Coronary spasm tended to occur in patients under inhalation anesthesia combined with epidural block. Nitrates alleviated the episode in the majority of cases, while defibrillation and cardiac massage were required in 19% of patients. No death was reported. Conclusion : The reported perioperative coronary spasm occurred mostly in elderly men who had certain preoperative risk factors, such as hypertension, angina pectoris, cigarette smoking and diabetes mellitus. Our findings suggest that the major factors that trigger perioperative coronary spasm include inadequate depth of general anesthesia, the use of vasopressors, vagus nerve stimulation, and drugs other than vasopressors. Perioperative coronary spasm is prevalent in patients undergoing abdominal or thoracic surgery under inhalational anesthesia combined with epidural anesthesia. Instability of the autonomic nervous system and/or vascular hyperreactivity has received considerable attention as the underlying pathogenic mechanisms of coronary spasm. In summary, perioperative coronary spasm is prevalent in elderly male patients with coronary risk factors, who undergo abdominal or thoracic surgery under inhalational anesthesia combined with epidural anesthesia. Instability of the autonomic nervous system and/or vascular hyperreactivity may be the underlying pathogenic mechanisms of perioperative coronary spasm.
In a porcine model of coronary artery spasm, the effects of epidural block or inhalational anesthesia on the incidence of serotonin-induced coronary hyperconstriction did not appeared, suggesting the minor contribution of anesthesia to coronary vasospasm in this porcine model. Less

Report

(4 results)
  • 1999 Annual Research Report   Final Research Report Summary
  • 1998 Annual Research Report
  • 1997 Annual Research Report
  • Research Products

    (21 results)

All Other

All Publications (21 results)

  • [Publications] Hoka, Yamaura K, Takenaka T, Takahashi S: "Propofol-induced incicsce in vas inlar capacitamce is due to inhibitton of symathetic naroconstrictive activity"Anestheriology. 89. 1495-1500 (1998)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] 外須美夫: "周術期心臓死のリスク因子"呼吸と循環. 47. 695-704 (1999)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] 外須美夫: "心室圧-容積関係と麻酔"臨床麻酔. 23. 637-643 (1999)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] 外須美夫: "心循環器障害を有する患者の術前評価"麻酔. 48(増). S117-S125 (1999)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] 松本知将,外須美夫,三谷浩之,永井一茂,穎川晋,馬場志郎: "麦角アルカロイト誘導体内服患者の麻酔導入後に発生した冠動脈攣縮"臨床麻酔. 24. 253-255 (2000)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] Koshiba K, Hoka S: "Clinical characteristics of perioperative coronary spasm : reviews of 115 case reports in Japan"Journal of Anesithesia. 15(in press). (2001)

    • Description
      「研究成果報告書概要(和文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] Hoka S.Yamaura K.Takenaka T.Takahashi S.: "Propofolinduced increase in vascular capacitance is due to inhibition of sympathetic vasoconstrictive activity."Anesthesiology. 89. 1495-1500 (1998)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] Hoka S: "Risk factors in perioperative cardiac death."Respiration and Circulation. 47. 695-704 (1999)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] Hoka S: "Ventricular pressure-volume relation and anesthesia."Journal of Clinical Anesthesia (Japan). 23. 637-643 (1999)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] Hoka S: "Perioperative evaluation for patients with cardiovascular impairment."Masui (Japanese Journal of Anesthesia). 48. S117-S125 (1999)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] Matsumoto T, Hoka S, Mitani H, Nagai K, Egawa S, Baba S: "Coronary artery vasospasm during anesthesia in a patient taking an ergot derivative."Journal of Clinical Anesthesia (Japan). 24. 253-255 (2000)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] Koshiba K, Hoka S: "Clinical characteristics of perioperative coronary spasm : reviews of 115 case reports in Japan."Journal of Anesthesia. 15 (in press). (2001)

    • Description
      「研究成果報告書概要(欧文)」より
    • Related Report
      1999 Final Research Report Summary
  • [Publications] Hoka S,Yamaura K,Takenaka T,Takahashi S.: "Propotol-induced"Anesthesiolgy. 89. 1945-1500 (1998)

    • Related Report
      1999 Annual Research Report
  • [Publications] 外 須美夫: "周術期心臓死のリスク因子"呼吸と循環. 47. 695-704 (1999)

    • Related Report
      1999 Annual Research Report
  • [Publications] 外 須美夫: "心室圧-容積関係と麻酔"臨床麻酔. 23. 637-643 (1999)

    • Related Report
      1999 Annual Research Report
  • [Publications] 外 須美夫: "心循環器障害を有する患者の術前評価"麻酔. 48(増). S117-S125 (1999)

    • Related Report
      1999 Annual Research Report
  • [Publications] 松本 知将,外須美夫,三谷浩之,永井一茂,瀬川晋,馬場志郎: "麦角アルカロイド誘導体内服患者の麻酔導入後に発生した冠動脈攣縮"臨床麻酔. 24. 253-255 (2000)

    • Related Report
      1999 Annual Research Report
  • [Publications] 外 須美夫: "ドパミンとドブタミンの周術期循環管理における使い分け"循環制御. 19. 160-164 (1998)

    • Related Report
      1999 Annual Research Report
  • [Publications] Hoka S,Yamaura K,Takenaka T,Takahashi S: "Propofolincrease propofol-induced increase in vesculen capcaitance is due to inhibition of sympathetic veroconstrictive activity" Auesthesiology. 89. 1945-1500 (1998)

    • Related Report
      1998 Annual Research Report
  • [Publications] Hoka S.et al.: "Removal of retained air during cardiac surgery with transesophapeal echocordiography and capnogrophy" Journal of Clinical Anesthesia. 9. 457-461 (1997)

    • Related Report
      1997 Annual Research Report
  • [Publications] 外 須美夫: "冠循環管理" 麻酔. 46(増). S26-S32 (1997)

    • Related Report
      1997 Annual Research Report

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Published: 1997-04-01   Modified: 2016-04-21  

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