Anesthesia with etomidate and remifentanil for cesarean section in a patient with severe peripartum cardiomyopathy

Patients with peripartum cardiomyopathy may require analgesia/ anesthesia for delivery or cesarean section. Many different methods of anesthesia has been used for this purpose. Remifentanil was used safely in peripartum cardiomyopathic patients, but there is not any report about etomidate usage in such patients. We report on a 19 years old patient, at 32 weeks of gestation, with severe peripartum cardiomyopathy, in uncompensated heart failure and pulmonary edema. She was scheduled for emergency cesarean section because of threatening mother's life and fetal distress. General anesthesia was induced with etomidate and maintained with remifentanil infusion safely, without any adverse outcome on mother or newborn

Assessment of the rapid shallow breathing index as a predictor of weaning of patients with prolonged mechanical ventilation

About 8% of patients experience prolonged mechanical ventilation after cardiac surgery. Development of criteria for successful liberation of a patient from mechanical ventilation and extubation may be highly dependent on the clinical situation. Different criteria were used for ventilator weaning. We designed a clinical trial to determine the usefulness of rapid shallow breathing index [RSBI] as a predictor for successful weaning from mechanical ventilation. In a prospective observational study, 52 patients who had prolonged mechanical ventilation [> 72 h] after open cardiac surgery were studied. Patients had 60 - min spontaneous breathing trials and satisfied at least 5 weaning predictors and fulfilled the criteria for discontinuing mechanical ventilation. Traditional weaning criteria and RSBI were determined. According to the outcome assessment of weaning, patients were divided into failure or success groups. The mean RSBI values were significantly different between the failure [103.5 +/- 21.9 breath/min/L] and success groups [80.4 +/- 15.3 breath/min/L, p=0.0001]. There was no significant difference regarding the values of other prediction criteria between the two groups. Using RSBI < 105 [breath/min/L] as the threshold value for predicting successful weaning, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and diagnostic accuracy were 92.5%, 70%, 92.5%, 70% and 88% respectively. Although a small number of patients require prolonged ventilatory support after open cardiothoracic surgeries, growing experience in critical care settings and mechanical ventilation cause favorable outcomes. Ventilator weaning is more likely to be successful if RSBI is less than 105 [breath/min/L]. This index is a more valuable and accurate predictor of weaning than other weaning predictors