Hemodynamic response to tracheal intubation and postoperative pharyngeal morbidity using GlideScope®, Lightwand and Macintosh laryngoscopes during remifentanil infusion

BACKGROUND: Use of GlideScope® laryngoscopes and lightwands for tracheal intubation does not require much force. Theoretically, less stimulation can reduce hemodynamic changes during intubation. We investigated the hemodynamic response to tracheal intubation using different laryngoscope types during remifentanil infusion. METHODS: Sixty American Society of Anesthesiologists class I-II patients were compared in terms of tracheal intubation time, hemodynamic changes, and postoperative pharyngeal complications when using a GlideScope®, lightwand, or Macintosh laryngoscope. Propofol and rocuronium were injected and remifentanil was infused for three minutes. Blood pressure and heart rate were measured before and 1, 3, and 5 minutes after tracheal intubation. Patients were assessed for postoperative oral and tracheal bleeding as well as hoarseness, dysphagia, and sore throat. RESULTS: Intubation time was prolonged in the GlideScope® group. All three groups showed a significant decrease in systolic and diastolic blood pressure 1, 3, and 5 minutesafter tracheal intubation. Heart rates increased significantly in all three groups immediately after intubation as well as 1 minute later in the GlideScope® group. However, there were no differences in blood pressure, heart rate, or the occurrence of hoarseness, dysphagia, and sore throat among the three groups. CONCLUSIONS: No differences in hemodynamic change were found among the three different techniques.

Hemodynamic response to tracheal intubation and postoperative pharyngeal morbidity using GlideScope®, Lightwand and Macintosh laryngoscopes during remifentanil infusion

BACKGROUND: Use of GlideScope® laryngoscopes and lightwands for tracheal intubation does not require much force. Theoretically, less stimulation can reduce hemodynamic changes during intubation. We investigated the hemodynamic response to tracheal intubation using different laryngoscope types during remifentanil infusion. METHODS: Sixty American Society of Anesthesiologists class I-II patients were compared in terms of tracheal intubation time, hemodynamic changes, and postoperative pharyngeal complications when using a GlideScope®, lightwand, or Macintosh laryngoscope. Propofol and rocuronium were injected and remifentanil was infused for three minutes. Blood pressure and heart rate were measured before and 1, 3, and 5 minutes after tracheal intubation. Patients were assessed for postoperative oral and tracheal bleeding as well as hoarseness, dysphagia, and sore throat. RESULTS: Intubation time was prolonged in the GlideScope® group. All three groups showed a significant decrease in systolic and diastolic blood pressure 1, 3, and 5 minutesafter tracheal intubation. Heart rates increased significantly in all three groups immediately after intubation as well as 1 minute later in the GlideScope® group. However, there were no differences in blood pressure, heart rate, or the occurrence of hoarseness, dysphagia, and sore throat among the three groups. CONCLUSIONS: No differences in hemodynamic change were found among the three different techniques.

Successful Hysterectomy and Therapeutic Hypothermia Following Cardiac Arrest due to Postpartum Hemorrhage / 대한구급학회지

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.

Hemisphere cerebral infarction after total laparoscopic hysterectomy in the Trendelenburg position: A case report

Perioperative stroke can lead to mortality or serious disability and usually occurs in patients undergoing cardiac, vascular, or neurologic surgery; it is rare in gynecological surgery. We report the case of a patient who suffered life-threatening cerebral infarction after elective laparoscopic hysterectomy. During the surgery, the patient was placed in the Trendelenburg position. On postoperative day one, the patient was diagnosed with right hemisphere cerebral infarction; brain computed tomographic angiography showed proximal right internal carotid artery occlusion. Decompressive craniectomy was performed to resolve brain swelling, but the patient died 10 days later.

Arginase Inhibition Restores Peroxynitrite-Induced Endothelial Dysfunction via L-Arginine-Dependent Endothelial Nitric Oxide Synthase Phosphorylation

PURPOSE: Peroxynitrite plays a critical role in vascular pathophysiology by increasing arginase activity and decreasing endothelial nitric oxide synthase (eNOS) activity. Therefore, the aims of this study were to investigate whether arginase inhibition and L-arginine supplement could restore peroxynitrite-induced endothelial dysfunction and determine the involved mechanism. MATERIALS AND METHODS: Human umbilical vein endothelial cells (HUVECs) were treated with SIN-1, a peroxynitrite generator, and arginase activity, nitrite/nitrate production, and expression levels of proteins were measured. eNOS activation was evaluated via Western blot and dimer blot analysis. We also tested nitric oxide (NO) and reactive oxygen species (ROS) production and performed a vascular tension assay. RESULTS: SIN-1 treatment increased arginase activity in a time- and dose-dependent manner and reciprocally decreased nitrite/nitrate production that was prevented by peroxynitrite scavenger in HUVECs. Furthermore, SIN-1 induced an increase in the expression level of arginase I and II, though not in eNOS protein. The decreased eNOS phosphorylation at Ser1177 and the increased at Thr495 by SIN-1 were restored with arginase inhibitor and L-arginine. The changed eNOS phosphorylation was consistent in the stability of eNOS dimers. SIN-1 decreased NO production and increased ROS generation in the aortic endothelium, all of which was reversed by arginase inhibitor or L-arginine. N(G)-Nitro-L-arginine methyl ester (L-NAME) prevented SIN-1-induced ROS generation. In the vascular tension assay, SIN-1 enhanced vasoconstrictor responses to U46619 and attenuated vasorelaxant responses to acetylcholine that were reversed by arginase inhibition. CONCLUSION: These findings may explain the beneficial effect of arginase inhibition and L-arginine supplement on endothelial dysfunction under redox imbalance-dependent pathophysiological conditions.

Successful Hysterectomy and Therapeutic Hypothermia Following Cardiac Arrest due to Postpartum Hemorrhage / 대한중환자의학회지

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.