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was recorded. Airway obstruction after laryngeal mask airway removal was evident in 20% of patients The purpose of this study is to compare the incidence in the deep anaesthesia group and in 8% of patients of undesirable respiratory events when the laryngeal in the awake group (P=0.007). In spite of this finding, mask airway is either removed from patients who oxygen desaturation in children of less than 6 years are fully awake or from patients who are deeply of age (SaO 2 < 96%) occurred most frequently after anaesthetized.Three-hundred patients aged awake removal (31.3%) compared with deep an-1.5-81 years were randomly assigned to have their aesthesia removal (4.5%) (P=0.023). laryngeal mask airway removed either when deeply anaesthetized or after airway reflexes had returned.Keywords: laryngeal mask airway, adverse res-The occurrence of adverse respiratory events (coughpiratory events, removal, recovery. ing, oxygen desaturation and airway obstruction)

The purpose of this study is to compare the incidence of undesirable respiratory events when the laryngeal mask airway is either removed from patients who are fully awake or from patients who are deeply anaesthetized. Three-hundred patients aged 1.5-81 years were randomly assigned to have their laryngeal mask airway removed either when deeply anaesthetized or after airway reflexes had returned. The occurrence of adverse respiratory events (coughing, oxygen desaturation and airway obstruction) was recorded. Airway obstruction after laryngeal mask airway removal was evident in 20% of patients in the deep anaesthesia group and in 8% of patients in the awake group (P = 0.007). In spite of this finding, oxygen desaturation in children of less than 6 years of age (SaO2 < 96%) occurred most frequently after awake removal (31.3%) compared with deep anaesthesia removal (4.5%) (P = 0.023).

A 45-year-old male patient after HTX in 2014 due to NICM was admitted with the signs and symptoms of heart failure. Severe mitral and tricuspid regurgitation and impaired systolic function of the graft were observed (LVEF 25%, RV hypokinesis). Vasculopathy was excluded, endomyocardial biopsy revealed no signs of acute cellular rejection (ACR 0). Due to the further deterioration, a decision of urgent heart retransplantation was made. A suitable donor with positive HBcAb antibodies and a negative HBs antigen was reported. After obtaining written informed consent, urgent orthotopic heart retransplantation was performed. The patient was vaccinated against hepatitis B, but the level of antibodies was undetectable. Pre-transplantation prophylaxis with lamivudine combined with subsequent valgancyclovir CMV prophylaxis was made. Active inflammatory cardiomyopathy of the explanted heart was diagnosed (histological examination). Inflammation of the transplanted heart was present despite no signs of cellular rejection in the endomyocardial biopsy. After the retransplantation signs of ACR in the 3a class were observed twice in the two first biopsies. High levels of GGTP (max. 692 U/l) and ALP (max. 214 U/l) were found in the second month after the transplantation. Transaminase and bilirubin levels were normal, abdominal US showed no pathology. The results improved in the follow-up. No manifestation of ACR and normal graft function were observed. After three months, valganciclovir prophylaxis was completed. The patient still received lamivudine (up to one year). In the repeated assessments, negative HBs antigen and low anti-HBs titers were found. Summary: We present a case report of heart retransplantation due to graft failure from an anti-HBcore positive and HBs antigen negative donor to a seronegative recipient. Based on anatomopathological and histopathological examination of the explanted graft, we also suggest that acute cellular rejection in the transplanted heart may exist despite negative findings in right-sided endomyocardial biopsy.

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