CASE 6—2001 exsanguinating endotracheal hemorrhage during cardiopulmonary bypass

Abstract

A 42-year-old, hypertensive man weighing 55 kg with triple-vessel coronary artery disease and a left ventricular ejection fraction of 0.5 was scheduled to undergo elective coronary artery bypass graft surgery. Preoperative evaluation was unremarkable except for a 5-year history of essential hypertension controlled with oral diltiazem, 60 mg twice daily. There were no respiratory complaints. The patient was premedicated with oral lorazepam, 2 mg. Anesthesia was induced with morphine, thiopental, and vecuronium to facilitate uneventful tracheal intubation, with a 9-mm cuffed endotracheal tube. A triple-lumen central venous catheter was introduced through the right internal jugular vein. After saphenous vein, left radial artery, and left internal mammary artery harvest, aortic and right atrial cannulation with a 2-stage cannula were performed with systemic heparinization. When the patient was on cardiopulmonary bypass (CPB), a cardiotomy sucker was introduced through a stab incision in the pulmonary artery (PA) to act as a PA vent. Surgery was uneventful, with 2 saphenous vein grafts to the right coronary artery and marginal, radial artery to the first marginal, and internal mammary to left anterior descending artery.