Laryngeal granuloma formation following endotracheal intubation for coronary artery bypass grafting surgery

Laryngeal granuloma formation is an uncommon complication following endotracheal intubation. We describe a case wherein a pedunculated laryngeal granuloma developed following endotracheal intubation for coronary artery bypass grafting (CABG) surgery. The intubation was atraumatic, and extubation in the ICU was without complication. Following an initial uneventful recovery, the patient developed laryngopharyngeal reflux and contracted an upper respiratory infection (URI), at which point she progressively developed hoarseness of voice and foreign body sensation over a period of three months. We present her case discussing the management of a massive pedunculated laryngeal granuloma. Key words: Laryngeal granuloma, vocal cord granuloma, endotracheal intubation, laryngopharyngeal reflux. Citation: Dhoon TQ, Ramezani A, Lozon C, Wong HS, Conte AH, Moallempour M. Laryngeal granuloma formation following endotracheal intubation for coronary artery bypass grafting surgery. Anaesth. pain intensive care 2022;26(6):811−814; DOI: 10.35975/apic.v26i6.2067

Arterial CO2 as a Potent Coronary Vasodilator: A Preclinical PET/MR Validation Study with Implications for Cardiac Stress Testing

Myocardial blood flow (MBF) is the critical determinant of cardiac function. However, its response to increases in partial pressure of arterial CO₂ (PaCO₂), particularly with respect to adenosine, is not well characterized because of challenges in blood gas control and limited availability of validated approaches to ascertain MBF in vivo. Methods: By prospectively and independently controlling PaCO₂ and combining it with ¹³N-ammonia PET measurements, we investigated whether a physiologically tolerable hypercapnic stimulus (∼25 mm Hg increase in PaCO₂) can increase MBF to that observed with adenosine in 3 groups of canines: without coronary stenosis, subjected to non-flow-limiting coronary stenosis, and after preadministration of caffeine. The extent of effect on MBF due to hypercapnia was compared with adenosine. Results: In the absence of stenosis, mean MBF under hypercapnia was 2.1 ± 0.9 mL/min/g and adenosine was 2.2 ± 1.1 mL/min/g; these were significantly higher than at rest (0.9 ± 0.5 mL/min/g, P < 0.05) and were not different from each other (P = 0.30). Under left-anterior descending coronary stenosis, MBF increased in response to hypercapnia and adenosine (P < 0.05, all territories), but the effect was significantly lower than in the left-anterior descending coronary territory (with hypercapnia and adenosine; both P < 0.05). Mean perfusion defect volumes measured with adenosine and hypercapnia were significantly correlated (R = 0.85) and were not different (P = 0.12). After preadministration of caffeine, a known inhibitor of adenosine, resting MBF decreased; and hypercapnia increased MBF but not adenosine (P < 0.05). Conclusion: Arterial blood CO₂ tension when increased by 25 mm Hg can induce MBF to the same level as a standard dose of adenosine. Prospectively targeted arterial CO₂ has the capability to evolve as an alternative to current pharmacologic vasodilators used for cardiac stress testing.