Case of myocardial infarction during emergency clipping surgery of a cerebral aneurysm

: An 80-year-old woman with subarachnoid hemorrhage underwent emergency neck clipping of a cerebral aneurysm. She had previously undergone surgery for an abdominal aortic aneurysm 10 years before. Anesthesia was induced with propofol and maintained with a combination of fentanyl and sevoflurane (0.5-1.5%) in air and oxygen. Ventricular fibrillation occurred immediately before clipping of the aneurysm, in the absence of preexisting myocardial ischemia, and recurred 4 times thereafter during the surgery. The ventricular fibrillation was successfully treated with cardioversion. We administered catecholamines, nitrates, calcium antagonists, nicorandil and heparin, following which the patient's hemodynamics gradually improved. After the operation, the patient was transferred to the cardiovascular center of a neighboring university where she successfully underwent emergency percutaneous transluminal coronary angioplasty. The patient was discharged from hospital 10 days later without any complications. Patients undergoing vascular surgical procedures or having a preoperative history of prior vascular surgery are at high risk for perioperative myocardial infarction. It is necessary to perform cardiac examination, including coronary angiography, preoperatively in such patients, even in those who are otherwise asymptomatic.