This study was designed to study the efficacy of intravenous dexmedetomidine for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation in patients with coronary artery disease. Sixty adult patients scheduled for elective off-pump coronary artery bypass surgery were randomly allocated to receive dexmedetomidine (0.5 mcg/kg) or normal saline 15 min before intubation. Patients were compared for hemodynamic changes (heart rate, arterial blood pressure and pulmonary artery pressure) at baseline, 5 min after drug infusion, before intubation and 1, 3 and 5 min after intubation. The dexmedetomidine group had a better control of hemodynamics during laryngoscopy and endotracheal intubation. Dexmedetomidine at a dose of 0.5 mcg/kg as 10-min infusion was administered prior to induction of general anaesthesia attenuates the sympathetic response to laryngoscopy and intubation in patients undergoing myocardial revascularization. The authors suggest its administration even in patients receiving beta blockers.

The clinical study was designed to evaluate and compare single preoperative dose of pregabalin to a placebo regarding hemodynamic responses to laryngoscopy and endotracheal intubation, to assess perioperative fentanyl requirement and any side-effects. It was a randomized, double-blind, placebo-controlled, parallel assignment, efficacy study. The study was done at a tertiary university hospital. This study was a comparison between two groups of 30 adult patients scheduled for elective off pump coronary artery bypass surgery. In the control group, the patients were given placebo capsules, and in the pregabalin group, the patients were given pregabalin 150 mg capsule orally 1 h before surgery. The patients were compared for hemodynamic changes before the start of the surgery, after induction, 1, 3, and 5 min after intubation. Additionally, fentanyl requirement during surgery and the first postoperative day was also compared. The present study shows that a single oral dose of 150 mg pregabalin given 1 h before surgery attenuated the pressor response to tracheal intubation in adults, but the drug did not show any effect on perioperative opioid consumption and was devoid of side-effects in the given dose.

A 15% of children with congenital heart disease also have an extracardiac abnormality. 1 Tetralogy of Fallot is occasionally associated with various well known extracardiac malformation. We report a rare extracardiac associatation of congenital bronchiectasis and Tetralogy of Fallot presented in late childhood with breathlessness on exertion and frequent respiratory infections. This late presentation was probably due to less destruction caused by oligemic lung of Tetralogy of Fallot. She was successfully managed by intracardiac repair and left upper lobectomy in a single setting. (Ind J Thorac Cardiovasc Surg 2010; 26: 34-37)

A 39 year-old lady with coarctation of the thoracic aorta and post stenotic double calcified aneurysm underwent single staged elective repair of the aneurysm and coarctation of the aorta. Computed tomographic angiogram showed coarctation of aorta at the level of the ductus and post stenotic aneurysm at the proximal descending thoracic aorta (3.5x4.9 cm). Another small saccular aneurysm (2.2x2.0) was seen 1 cm distal to the above mentioned aneurysmal dilatation. Left subclavian artery showed severe narrowing at the origin. Coronary angiogram revealed coarctation of aorta at the level of aortic arch followed by post stenotic calcific aneurysmal dilatation. The aneurysmal pressure was 112 mm Hg and pull back gradient was 60 mm Hg. The entire coarctated segment along with the origin of the subclavian up to the middle of the descending thoracic aorta was excised. An 18 mm Dacron graft was sutured end-to-end to the arch of the aorta distal to the left carotid and end-to-end to the descending thoracic aorta above the diaphragm. The patient had an uneventful course and the postoperative echocardiographic follow up showed no gradient and concentric hypertrophy. The authors examine the special considerations in the treatment of this infrequent clinical condition.