Background and Objectives In order to reduce the surgical stress on the heart, anesthesiologists frequently use regional anesthesia in patients with coronary artery disease.

Methods Two patients underwent reconstructive peripheral vascular surgery under continuous epidural anesthesia with bupivacaine. During the surgery and later in the recovery room, they received continuous electrocardiographic (ECG), invasive arterial blood pressure, and oxyhemoglobin saturation monitoring.

Results In both patients, the anesthetic course during surgery was uneventful, but while recovering from the anesthesia, they developed ECG changes consistent with myocardial ischemia, followed by malignant dysrhythmias and cardiac arrest. The clinical pictures, ECGs, coronary angiogram, and (in one patient) autopsy findings suggested coronary artery spasm as the cause of the malignant dysrhythmias and cardiac arrests.

Conclusions It is possible that the coronary spasms were caused by an altered balance between sympathetic and parasympathetic nervous activity during recovery from epidural anesthesia. Therefore, patients with coronary artery disease must be closely monitored for signs and symptoms of myocardial ischemia during the entire recovery period from epidural anesthesia.