Evaluation of the Hemodynamic Response to Endotracheal Intubation Comparing the Airtraq(®) with Macintosh Laryngoscopes in Cardiac Surgical Patients.

INTRODUCTION: Cardiac patients are more prone to develop hemodynamic instability on induction of anesthesia and endotracheal intubation. The Airtraq(®) optical laryngoscope is a single-use rigid video laryngoscope that has been developed to facilitate tracheal intubation. There are limited studies comparing differences in the circulatory responses to Airtraq(®) and direct Macintosh larynngoscopy in cardiac patients. AIM: The purpose of our study was to evaluate whether there was clinically significant difference between the hemodynamic response to orotracheal intubation guided by either of the two devices (Airtraq(®) and Macintosh laryngoscopes) in patients who underwent coronary artery bypass grafting surgery. MATERIAL AND METHODS: In this clinical study we analyzed the hemodynamic response to endotracheal intubation performed with Airtraq(®) or Macintosh laryngoscopes in patients who underwent elective coronary artery bypass graft surgery under general anesthesia. RESULTS: We analyzed: blood pressure (systolic, diastolic, mean), heart rate and peripheral oxygen saturation (all notified before induction in anesthesia, immediately after induction, at the time of intubation and thereafter one and five minutes after intubation). We also recorded the maximal values of blood pressure and heart rate, as well as calculated the product of heart rate and systolic blood pressure. There were statistically significant differences in the hemodynamic response between the groups. At the time of intubation, there was significant inter-group difference in heart rate, systolic, diastolic and mean blood pressure. Endotracheal intubation with Macintosh laryngoscope was accompanied by significant increase in blood pressure and heart rate compared to Airtraq(®) group. CONCLUSION: The Airtraq(®) laryngoscope performed better than the Macintosh laryngoscope in terms of hemodynamic to the patient undergoing routine coronary artery bypass graft surgery.

Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease.

INTRODUCTION: The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. CASE REPORT: A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. CONCLUSION: Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

[Myocardial dysfunction in septic shock--a case report].

INTRODUCTION: Sepsis is characterized by generalized inflammatory response induced by infection. The incidence of myocardial dysfunction in sepsis is unknown as well as its impact on survival, independently other organ system dysfunction. CASE REPORT: A female patient, age 36, with clinical signs of septic shock was admitted to the Intensive Care Unit. After initial therapy of septic shock, patient was still haemodynamically unstable. Transthoracic echocardiography showed left ventricular dysfunction (EF = 20%), with mitral regurgitation 2-3+, tricuspid regurgitation 3+, and estimated systolic right ventricular pressure of 53 mm Hg. Inotropic drug, dobutamine, was initiated, which led to significant improvement of hemodynamic parameters. Eight days after the initiation of therapy the clinical improvement was observed and the control transthoracic echocardiography was performed. It showed the improvement in left ventricular size and function, with EF of 57%, and reduced mitral regurgitation to 2+, and tricuspid regurgitation to 1+. DISCUSSION: A hyperdynamic state is typically present in sepsis. Myocardial dysfunction in sepsis is characterized by decreased ejection fraction, ventricular dilatation and impaired contractile response to volume loading. Cardiac output can be measured using pulmonary artery catheter, transthoracic and transoesophageal echocardiography, or by pulse contour analysis. In this patient, myocardial dysfunction was detected by echocardiography, which helped in clinical decision making to administer inotropic agent. The recovery of myocardial function was also confirmed by echocardiography. CONCLUSION: Echocardiography can be used in septic patient for diagnosis of myocardial dysfunction, decision making, follow-up of the response to inotropic therapy, and detection of the complete recovery of cardiac function.