| Abstract | We present here a patient who experienced ST depression during thoracic cavity irrigation under general and epidural anesthesia. 「Case report」A 74-year-old man, 160cm tall, and weighing 34kg, underwent bullectomy and fistula closure for right pneumothorax after unsuccessful conservative therapy. His surgical history included gastrectomy at the age of 46 for gastric ulcer and two times of aortofemoral bypass for ASO at 70 and 71 years. Preoperative ECG showed a q wave in leads II, III, aVF(Fig. 1). Preoperative laboratory examinations were all within normal limits. Atropine 0.4mg was intramuscularly administered prior to anesthesia. With stamdard ECG monitoring, epidural puncture was performed at the T6-7 interspace by the loss-of-resistance method using physiological saline. A catheter was inserted 5cm into the epidural space via a Tuohy needle. A bolus 5ml of 2% mepivacaine provided analgesic region at T3-10. Thereafter, a left-sided double lumen tube was placed after induction of general anesthesia with 34mg of propofol and 3mg of vecuronium. Anesthesia was maintained with intermittent epidural anesthesia, and infusion of propofol and vecuronium. After closure of the fistula, a surgeon irrigated the right thorax with warm physiological saline to assess the integrity of the right upper lobe stump suture line. The temperature of the irrigation solution was not directly measured. Immediately after starting irrigation, ST segment on ECG decreased significantly(maximum：-1.66mV, lead II)(Fig. 2). |
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