Myocardial ischaemia during tracheal extubation in patients after cardiac surgery: an observational study.

This study examines whether there is a temporal relationship between tracheal extubation and myocardial ischaemia in haemodynamically stable patients extubated within 6 h of cardiac surgery. Fifty-two patients were studied during three time periods: 1, from 2 h until 30 min before extubation (90 min); 2, from 30 min before until 30 min after extubation (60 min); 3, from 30 min until 2 h after extubation (90 min). Significant ST segment changes were defined as a reversible ST segment depression of 2 mm or greater or an elevation of 3 mm or greater from baseline, lasting for 1 min or more. Fourteen patients (26.9%) had ST segment changes. The ischaemic burden in periods 2 and 3 was increased compared with that in period 1; the mean (SD) was: period 1, 19.2 (18.8) min; period 2, 35.4 (24.9) min; period 3, 39.6 (24.5) min; however, the mean ST deviation (mm) did not change. ST segment changes were associated with an increased heart rate; they were not related to arterial pressure. We conclude that there is a temporal relationship between ST segment changes and tracheal extubation after cardiac surgery.

Osteomyelitis complicating Streptococcus milleri endocarditis.

A patient with osteomyelitis of the spine complicating bacterial endocarditis due to Streptococcus milleri is discussed. To our knowledge, this is the first time this organism has been associated with this complication.