Two Cases of Takotsubo Syndrome Related to Tracheal Intubation/Extubation

Triin Jakobson¹, Nikolai Svitškar¹, Kadri Tamme^{1, 2}, Joel Starkopf^{1, 2}, Juri Karjagin^{1, 2}

¹Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, ²Anaesthesiology and Intensive Care Clinic, University of Tartu, Estonia

Key words: Takotsubo cardiomyopathy; intubation; extubation; sympathetic stress.

Summary. Takotsubo cardiomyopathy is an acute, reversible left ventricular dysfunction with characteristic contractility disorder and is usually preceded by emotional or physical stress. Two cases of Takotsubo cardiomyopathy related to tracheal manipulation are presented. Both the patients had all the typical symptoms and signs of Takotsubo cardiomyopathy, and both of them recovered completely within weeks. Tracheal manipulation is a well-known stress factor during the perioperative period, and experience from these two cases stresses the crucial role of measures aimed to stress reduction. Proper premedication and calm environment are recommended to produce anxiolysis before intubation. The administration of α- and β-blockers is also recommended to inhibit sympathetic stress caused by tracheal manipulation.

Correspondence to T. Jakobson, Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Puusepa 8, 50408 Tartu, Estonia. E-mail: Triin.Jakobson@kliinikum.ee

Received 6 May 2011, accepted 28 February 2012