{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:55:17Z","timestamp":1787496917040,"version":"build-2736575974"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Kounis syndrome (KS), also known as allergic angina syndrome, is a potentially life-threatening perioperative condition that may be underrecognized under general anesthesia. Management is challenging because anaphylaxis and acute coronary events can occur concurrently and progress to cardiac arrest. We report a 70-year-old man undergoing elective left thoracoscopic lobectomy under general anesthesia. During the procedure, he developed abrupt hypotension and ST-segment elevation followed by ventricular fibrillation (VF). Cardiopulmonary resuscitation (CPR) was initiated, and 1 mg intravenous (IV) epinephrine was administered. The first defibrillation attempt failed to restore an organized rhythm. Marked erythema on both upper extremities was noted and intraoperative anaphylaxis was suspected. Despite anti-anaphylaxis treatment and two additional defibrillation attempts, there was no response. A cardiologist was consulted and internal defibrillation was initiated. After opening the pericardium, papaverine was administered. Sinus rhythm was obtained after the fourth defibrillation, with a total resuscitation time of 29 min. The patient was transferred to the intensive care unit (ICU) and was ultimately diagnosed with Type I Kounis syndrome. He was discharged without complications. This case suggests that in patients without underlying coronary artery disease, reversible coronary vasospasm may represent a pre-dominant pathophysiological mechanism in Type I Kounis syndrome. Early consideration of coronary vasodilator therapy, alongside standard anaphylaxis management, may therefore be warranted in selected perioperative settings.<\/jats:p>","DOI":"10.3389\/fmed.2026.1766987","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:40:13Z","timestamp":1777527613000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Turn left or turn right? Lessons from the management of intraoperative cardiac arrest due to Type I Kounis syndrome: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuanyuan","family":"Rong","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaolei","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haishan","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-be","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianfeng","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Fourth Hospital of Hebei Medical University","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, 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