P Pu ur rp po os se e: : To compare intubating conditions and cardiovascular changes following induction of anesthesia and tracheal intubation in patients receiving either lidocaine-remifentanil-propofol or lidocaine-remifentanil-thiopental prior to induction.

The combination of propofol and ketamine for invasive procedures in pediatric oncology resulted in reduced propofol and fentanyl consumption and preserved hemodynamic stability, but more children in the combination group recovered with agitation.

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CaseMr C is a 55 year old male without history of coronary artery disease (CAD) and good exercise tolerance with METS of 7-10. Family history of CAD is the only risk factor in his history. The patient underwent an extensive abdominal and pelvic surgery for urinary bladder cancer. The intraoperative course involved massive transfusion but there was no hypotension, and pressors were not needed. Postoperatively he was left intubated on mechanical ventilation and aggressive resuscitaion continued in the ICU. Patient was extubated after 24 hours. On postoperative day 2 he developed sinus tachycardia, heart rate 130-150, without hypotension or desaturation. Cardiac troponins were elevated. Work up for pulmonary embolism was negative. Transthoracic echocardiography showed no wall motion abnormality. Cardiologist diagnosed him with 'troponin leak' without need for further cardiac workup.Cardiac troponins are regulatory proteins that control the calciummediated interaction of actin and myosin. The troponin complex consists of 3 subunits, troponin T, troponin I, and troponin C.Specificity for cardiac isoforms is the basis for the clinical utility of troponin T and troponin I assays. Troponin C is not used clinically because both cardiac and smooth muscle share troponin C isoforms.Troponin elevations are indicative of myocardial injury in patients who are critically ill, especially patients with systemic inflammatory response syndrome (SIRS) and sepsis, and are associated with worse prognosis. In a recent study Elevated cTnI was an independent prognosticator of mortality (odds ratio, 2.020; 95% confidence interval, 1.153-3.541) after adjusting for other significant variables.Also, Vasile et al. [24] found that in patients admitted to the ICU for respiratory disorders, cTnT elevations are independently associated with in-hospital, short-term and long-term mortality. AbstractA common problem in the intensive care unit is interpreting elevated cardiac biomarkers in patients hospitalized for serious non-cardiac diseases. The following case example demonstrates the importance of the clinical context when interpreting the cardiac biomarkers in critically ill patients. Elevated cTn in critically ill patient should be investigated thoroughly and distinction between Type1 myocardial infarction from Type 2 is established. There are numerous causes of troponin release due to myocardial damage, while some are related to myocardial ischemia others are not. Discrimination of Type 2 MI from Type 1 MI and troponin release due to non-coronary diseases is challenging. However, discrimination is paramount in order to provide timely and appropriate treatment.