[Coronary artery spasm immediately after insertion of a laryngeal mask airway during induction of general anesthesia].

We describe the case of a 73-year-old woman scheduled for tendon sheath release for carpal tunnel syndrome under general anesthesia. Preoperatively, she had hypertension and complete right bundle branch block with normal left ventricular function. During general anesthetic induction, immediately after insertion of the laryngeal mask airway, her electrocardiogram (ECG) showed remarkable ST segment elevation followed by complete atrio-ventricular block. Transcutaneous cardiac pacing was immediately started and nitroglycerin was administered. Nine minutes after starting cardiac pacing, the level of the ST segment and heart rate returned to baseline. The surgical procedure was postponed and the patient was admitted to the coronary care unit. Thereafter, her ECG remained normal. Coronary artery spasm was suspected due to the transient nature of the cardiac symptoms, although the cause of the spasm was not clear. Coronary artery spasm can occur even in patients with relatively low cardiovascular risks. Hence, it is essential to be vigilant about all kinds of circulatory changes, including ECG changes, and to be prepared with the drugs and devices required to deal with sudden untoward cardiac events.