COVID-19 - Toward a comprehensive understanding of the disease.

The evidence on the pathophysiology of the novel coronavirus SARS-CoV-2 infection is rapidly growing. Understanding why some patients suffering from COVID-19 are getting so sick, while others are not, has become an informal imperative for researchers and clinicians around the globe. The answer to this question would allow rationalizing the fear surrounding this pandemic. Understanding of the pathophysiology of COVID-19 relies on an understanding of interplaying mechanisms, including SARS-CoV-2 virulence, human immune response, and complex inflammatory reactions with coagulation playing a major role. An interplay with bacterial co-infections, as well as the vascular system and microcirculation affected throughout the body should also be examined. More importantly, a compre-hensive understanding of pathological mechanisms of COVID-19 will increase the efficacy of therapy and decrease mortality. Herewith, presented is the current state of knowledge on COVID-19: beginning from the virus, its transmission, and mechanisms of entry into the human body, through the pathological effects on the cellular level, up to immunological reaction, systemic and organ presentation. Last but not least, currently available and possible future therapeutic and diagnostic options are briefly commented on.

Accelerated heart function recovery after therapeutic plasma exchange in patient treated with biventricular mechanical circulatory support for severe peripartum cardiomyopathy.

We describe a case of severe peripartum cardiomyopathy treated with biventricular mechanical circulatory support, where rapid haemodynamic recovery was observed after therapeutic plasma exchange, used as an adjunct to the inhibition of prolactin release. The patient recovered and after 2 months was discharged from the hospital without clinical symptoms of heart disease.

Complications after using the Airtraq laryngoscope for a predicted difficult intubation.

Although standard management of an expected difficult intubation is based on fibre-optic techniques, the application of optical laryngoscopes such as Airtraq is gaining widespread acceptance. We here describe a case where an intubation attempt with the Airtraq laryngoscope was not only unsuccessful, but negatively influenced subsequent use of a flexible fibroscopic approach.

Iliac artery injury during lumbar microdiscectomy.

BACKGROUND: Accidental laceration of major abdominal vessels during lumbar disc surgery is a relatively rare complication that requires rapid diagnosis and management. CASE REPORT: A 25-yr-old woman, operated on for an L4-L5 disc hernia, developed cardiovascular collapse after disc removal. This was treated with volume replacement and ephedrine, and a postoperative CT scan revealed a large retroperitoneal haematoma. During an immediate laparotomy, a 10 cm laceration of the left iliac artery was repaired and massive blood loss replaced (to lowest haemoglobin concentration during the surgery was 2.1 mmol L(-1)).The patient made a full recovery. CONCLUSION: In any case of unexpected hypotension during lumbar disc herniation surgery, accidental vascular damage should be suspected and a CT scan performed immediately.

[Effects of sevoflurane versus target-controlled infusion of propofol on haemodynamics during elective breast surgery in healthy women]. / Zmiany parametrów hemodynamicznych podczas podtrzymywania znieczulenia propofolem lub sewofluranem.

BACKGROUND: Haemodynamic changes during general anaesthesia are still being widely investigated. Although propofol and sevoflurane are commonly used anaesthetic agents, there is a lack of comparative studies assessing their influence on haemodynamic parameters. We have assessed whether the effects of target-controlled propofol anaesthesia on HR, MAP and cardiac output, are different from those seen with a sevoflurane-based protocol. METHODS: ASA I and II females, scheduled for elective breast surgery, were studied. After premedication with midazolam and intravenous induction with propofol, fentanyl and vecuronium bromide, general anaesthesia was maintained with either 1 MAC sevoflurane in oxygen/air (group S), or a target-controlled infusion of 3 micromL(-1) propofol (group P). Both groups received additional fentanyl. Heart rates and mean arterial pressures were noted and compared. Stroke volumes, cardiac outputs and cardiac indexes were measured every 3 min, using a non-invasive carbon dioxide rebreathing method (NICO). RESULTS: Fifty-seven patients were enrolled in the study. Comparisons between the groups revealed a significant decrease in mean heart rate during maintenance of anaesthesia with propofol (p<0.05), but not with sevoflurane. Although cardiac output and cardiac index were lower in group P towards the end of analysis, no statistically significant differences in HR, MAP, SV, CO or CI were found between the groups. CONCLUSION: The haemodynamic effect of a target 3 micromL(-1) propofol infusion did not differ significantly from that observed with 1 MAC sevoflurane.