http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Wed, 22 May 2013 16:02:02 +0000 http://www.hindawi.com/crim/anesthesiology/2013/736790/ Introduction. It is a consensus that the postoperative cognitive function is impaired in elderly patients after general anaesthesia, and such category patient takes more time to recover. Xenon is a noble gas with anesthetic properties mediated by antagonism of N-methyl-D-aspartate receptors. With a minimum alveolar concentration of 0.63, xenon is intended for maintaining hypnosis with 30% oxygen. The fast recovery after xenon anaesthesia was hypothesized to be advantageous in this scenario. Case Presentation. We report the case of 99-year-old woman who underwent sigmoid colon carcinoma resection with colorectal anastomosis. We carried out the induction phase by propofol, oxygen, fentanil, and rocuronium bromide, and then we proceeded to a rapid sequence endotracheal intubation consequently. The patient was monitored by IBP, NIBP, ECG, cardiac frequency, respiratory rate, capnometry, TOF Guard, blood gas analysis, and BIS. For maintenance we administrated oxygen, remifentanil, rocuronium bromide, and xenon gas 60–65%. Shortly after the end of surgery the patients started an autonomous respiratory activity, and a high BIS level was also recorded. Decision was made by our team to proceed into the emergence phase. The residual neuromuscular block was antagonized by sugammadex, modified Aldrete score was implicated, and we got our patient fully awake without any cognitive dysfunction or delirium. Conclusion. The rapid emergence to full orientation in very elderly patient who had been anesthetized by xenon shows concordance to the high BIS values and the clinical signs of the depth of anesthesia. Maria Sanfilippo, Ahmed Abdelgawwad Wefki Abdelgawwad Shousha, and Antonella Paparazzo Copyright © 2013 Maria Sanfilippo et al. All rights reserved. Wed, 10 Apr 2013 15:26:34 +0000 http://www.hindawi.com/crim/anesthesiology/2013/321054/ In some conditions continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) therapy alone fails to provide satisfactory oxygenation. In these situations oxygen (O2) is often being added to CPAP/BIPAP mask or hose. Central sleep apnea and obstructive sleep apnea (OSA) are often present along with other chronic conditions, such as chronic obstructive pulmonary disease (COPD), congestive heart failure, pulmonary fibrosis, neuromuscular disorders, chronic narcotic use, or central hypoventilation syndrome. Any of these conditions may lead to the need for supplemental O2 administration during the titration process. Maximization of comfort, by delivering O2 directly via a nasal cannula through the mask, will provide better oxygenation and ultimately treat the patient with lower CPAP/BIPAP pressure. Jahan Porhomayon, Gino Zadeii, Nader D. Nader, George R. Bancroft, and Alireza Yarahamadi Copyright © 2013 Jahan Porhomayon et al. All rights reserved. Wed, 10 Apr 2013 09:09:08 +0000 http://www.hindawi.com/crim/anesthesiology/2013/723815/ In the field of anesthesiology, there is wide debate on discontinuing angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy the day of noncardiac surgery. Although there have been many studies attributing perioperative hypotension to same-day ACEI and ARB use, there are many additional variables that play a role in perioperative hypotension. Additionally, restoring blood pressure in these patients presents a unique challenge to anesthesiologists. A case report is presented in which a patient took her ACEI the day of surgery and developed refractory hypotension during surgery. The evidence of ACEI use on the day of surgery and development of hypotension is reviewed, and additional variables that contributed to this hypotensive episode are discussed. Lastly, current challenges in restoring blood pressure are presented, and a basic model on treatment approaches for refractory hypotension in the setting of perioperative ACEI use is proposed. Karan Srivastava, Vikas Y. Sacher, Craig T. Nelson, and John I. Lew Copyright © 2013 Karan Srivastava et al. All rights reserved. Wed, 03 Apr 2013 13:52:06 +0000 http://www.hindawi.com/crim/anesthesiology/2013/852143/ Opioids have been considered for their hemodynamic stability. Remifentanil is an opioid analgesic with rapid metabolism and fast primary effect and recovery. In this paper, a very rare effect of using remifentanil along with propofol was presented. An 84-year-old male patient with severe aortic stenosis underwent general anesthesia. In order to induce anesthesia and maintain it, fentanyl, pancuronium, and propofol, along with a combination of propofol and remifentanil, were used, respectively. At beginning of remifentanil infusion, bradycardia and then Mobitz type II conduction block with a hemodynamic disorder occurred for the patient. The decreased blood pressure responded to injection of atropine and ephedrine; however, dysrhythmia only improved after cessation of remifentanil. Therefore remifentanil should be used with caution in aortic stenosis. Mehryar Taghavi Gilani and Majid Razavi Copyright © 2013 Mehryar Taghavi Gilani and Majid Razavi. All rights reserved. Wed, 27 Mar 2013 16:45:54 +0000 http://www.hindawi.com/crim/anesthesiology/2013/512915/ Anesthetic management of laboring parturients with Arnold-Chiari type I malformation poses a difficult challenge for the anesthesiologist. The increase in intracranial pressure during uterine contractions, coughing, valsalva maneuvers, and expulsion of the fetus can be detrimental to the mother during the process of labor and delivery. No concrete evidence has implicated high cerebral spinal fluid pressure on maternal and fetal complications. The literature on the use of neuraxial techniques for managing parturients with Arnold-Chiari is extremely scarce. While most anesthesiologists advocate epidural analgesia for management of labor pain and spinal anesthesia for cesarean section, we are the first to report the use of combined spinal-epidural analgesia for managing labor pain in a pregnant woman with Arnold-Chiari type I malformation. Also, we have reviewed the literature and presented information from case reports and case series to support the safe usage of neuraxial techniques in these patients. Clark K. Choi and Kalpana Tyagaraj Copyright © 2013 Clark K. Choi and Kalpana Tyagaraj. All rights reserved. Wed, 27 Mar 2013 14:13:40 +0000 http://www.hindawi.com/crim/anesthesiology/2013/568373/ Tracheal rupture is a rare complication of endotracheal intubation. We present a case of tracheal rupture that was diagnosed intraoperatively after the use of an NIM EMG endotracheal tube. A 66-year-old female with a recurrent multinodular goiter was scheduled for total thyroidectomy. Induction of anesthesia was uncomplicated. Intubation was atraumatic using a 6 mm NIM EMG endotracheal tube (ETT). Approximately 90 minutes into the surgery, a tracheal tear was suspected. After confirming the diagnosis, conservative treatment with antibiotic coverage was favored. The patient made a full recovery with no complications. Diagnosis of the tracheal tear was made intraoperatively, prompting early management. Minal Joshi, Simon Mardakh, Joel Yarmush, H. Kamath, Joseph Schianodicola, and Ernesto Mendoza Copyright © 2013 Minal Joshi et al. All rights reserved. Tue, 19 Mar 2013 08:59:29 +0000 http://www.hindawi.com/crim/anesthesiology/2013/408670/ Retinoblastoma is one of the most common ophthalmic neoplasms affecting children worldwide. Since its recent introduction, superselective ophthalmic artery injection of chemotherapy with melphalan has significantly reduced the need for enucleation in patients with advanced disease and also shown to have minimal adverse effects on visual acuity as compared to the conventional therapy. Although no severe complications resulting in strokes or deaths have been reported, this treatment modality is not without difficulties. In this case discussion, we describe an event that has occurred to several pediatric patients undergoing superselective angiography of the ophthalmic artery that may be due to an oculopulmonary type reflex causing significant hemodynamic instability and hypoxemia. Stephan Klumpp, Lydia M. Jorge, and Mohammed Ali Aziz-Sultan Copyright © 2013 Stephan Klumpp et al. All rights reserved. Thu, 14 Mar 2013 18:54:51 +0000 http://www.hindawi.com/crim/anesthesiology/2013/716756/ Pycnodysostosis (the Toulouse-Lautrec syndrome) is a rare autosomal-recessive disorder of osteoclast dysfunction. This disorder was first described by Maroteaux and Lamy in 1962. We describe anaesthetic management of a 35-year-old female having pyknodysostosis with fracture shaft left femur with anticipated difficult intubation. Therefore, spinal anesthesia was planned for her fracture fixation. The intra- and postoperative period remains uneventful. Rajeev Puri, Arpita Saxena, Awak Mittal, Zia Arshad, Yogita Dwivedi, Trilok Chand, Apurva Mittal, Archna Agrawal, Jay Prakash, and Sathiyanarayanan Pilendran Copyright © 2013 Rajeev Puri et al. All rights reserved. Tue, 22 Jan 2013 09:09:07 +0000 http://www.hindawi.com/crim/anesthesiology/2013/253218/ The developments of new spinal needles and needle tip designs have reduced the incidence of postdural puncture headache (PDPH). Although it is clear that reducing the loss of CSF leak from dural puncture reduces the headache, there are areas regarding the pathogenesis, treatment, and prevention of PDPH that remain controversial. Air travel by itself may impose physiological alteration in central nervous system that may be detrimental to patients with PDPH. This case report highlights a case of a young female patient who suffered from a severe incapacitating PDPH headache during high-altitude flight with a commercial jet. Jahan Porhomayon, Gino Zadeii, Alireza Yarahamadi, and Nader D. Nader Copyright © 2013 Jahan Porhomayon et al. All rights reserved. Wed, 12 Dec 2012 18:05:50 +0000 http://www.hindawi.com/crim/anesthesiology/2012/748748/ Administering neuraxial anesthesia to a patient with an underlying neurological disease and a combination of four other pathological disorders can be challenging. We report in this paper the case of a 45-year-old woman with neurological deficit due to ischemic brain infarct, multiple sclerosis, antiphospholipid syndrome, and β-heterozygous thalassemia that was subjected to abdominal hysterectomy and bilateral salpingoophorectomy under epidural anesthesia for ovarian cancer. Aliki Tympa, Dimitrios Hassiakos, Nikolaos Salakos, and Aikaterini Melemeni Copyright © 2012 Aliki Tympa et al. All rights reserved. Wed, 12 Dec 2012 17:30:52 +0000 http://www.hindawi.com/crim/anesthesiology/2012/841051/ Hernandez first described the submental route for endotracheal intubation in 1986 as an alternative airway maneuver for maxillofacial procedures. Since that time, several case studies have been performed demonstrating the efficacy of the submental approach. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture necessitating maxillomandibular fixation. Unlike most of the cases described in the literature, this patient’s operative course was confounded by the need to extubate through the submental tunnel. The patient tolerated the procedure well and was able to avoid other forms of surgical airway. Santosh Kumar Yadav and Gopendra Deo Copyright © 2012 Santosh Kumar Yadav and Gopendra Deo. All rights reserved. Thu, 22 Nov 2012 10:41:53 +0000 http://www.hindawi.com/crim/anesthesiology/2012/607140/ With recent advancements in clinical science, an increasing number of patients with congenital heart defects are surviving into adulthood and presenting for noncardiac surgeries. We describe one such example of a 26-year-old patient with corrected hypoplastic left heart syndrome presenting for knee arthroscopy and performed under general anesthesia with preoperative ultrasound guided saphenous nerve block. In this case, we review the anesthetic implications of corrected single ventricle physiology, anesthetic implications, as well as discuss the technique and role of saphenous nerve block in patients undergoing knee arthroscopy. Jennifer Knautz, Yogen Asher, Mark C. Kendall, and Robert Doty Jr. Copyright © 2012 Jennifer Knautz et al. All rights reserved. Wed, 21 Nov 2012 11:47:28 +0000 http://www.hindawi.com/crim/anesthesiology/2012/718594/ Autistic children are very difficult to manage in the hospital setting because they react badly to any change in routine. We describe a case of 10-year-old male patient with severe autism undergoing orchidopexy and circumcision. Following premedication, anesthesia was induced with remifentanil, propofol, atracurium, and maintained with total intravenous anesthesia (propofol and remifentanil). The Bispectral Index System was monitored for determination of the depth of anesthesia. After surgery, all infusions were discontinued. The patient was then transferred to the postanesthetic care unit. There were no adverse events observed during the anesthetic management. The patient was discharged from the hospital on the second postoperative day. Bispectral Index System-guided Total Intravenous Anesthesia can provide some advantages for patient with autism, such as hemodynamic stability, early and easy recovery, to facilitate faster discharge, to optimize the delivery of anesthetic agents, to minimize its adverse effects, and to maximize its safety. Selçuk Okur, Müge Arıkan, Gülşen Temel, and Volkan Temel Copyright © 2012 Selçuk Okur et al. All rights reserved. Wed, 10 Oct 2012 11:47:21 +0000 http://www.hindawi.com/crim/anesthesiology/2012/586235/ Background. Morbid obesity in a pregnancy is a great challenge to medical practice especially when the patient requires caesarean section. Case Summary. A 38-year-old unbooked gravida 3 Para 2+0 weight 195 kg, height 1.7 m with a blood pressure of 210/160 mmhg had spinal anaesthesia for emergency caesarean section which was technically difficult for severe preeclampsia at 32-week gestation. She had poor wound healing and spent 18 days postoperatively on hospital admission. Conclusion. Morbid obesity is a challenge to both obstetric and anaesthetic practice. Antenatal care is necessary in reducing both maternal morbidity and mortality. Ebirim N. Longinus, Lagiri Benjamin, and Buowari Yvonne Omiepirisa Copyright © 2012 Ebirim N. Longinus et al. All rights reserved. Mon, 08 Oct 2012 11:12:59 +0000 http://www.hindawi.com/crim/anesthesiology/2012/203240/ Dexmedetomidine is an α2-receptor agonist commonly used for sedation and analgesia in ICU patients. Dexmedetomidine is known to provide sympatholysis and also to have direct atrioventricular and sinoatrial node inhibitory effects. In rare instances, orthotopic lung transplantation has been associated with disruption of autonomic innervation of the heart. The combination of this autonomic disruption and dexmedetomidine may be associated with severe bradycardia and/or asystole. Since orthotopic lung transplant patients with parasympathetic denervation will not respond with increased heart rate to anticholinergic therapy, bradyarrhythmias must be recognized and promptly treated with direct acting beta agonists to avoid asystolic cardiac events. Christopher Allen-John Webb, Paul David Weyker, and Brigid Colleen Flynn Copyright © 2012 Christopher Allen-John Webb et al. All rights reserved. Tue, 02 Oct 2012 15:00:03 +0000 http://www.hindawi.com/crim/anesthesiology/2012/370412/ Fetal hydantoin syndrome is a rare disorder that is believed to be caused by exposure of a fetus to the anticonvulsant drug phenytoin. The classic features of fetal hydantoin syndrome include craniofacial anomalies, prenatal and postnatal growth deficiencies, underdeveloped nails of the fingers and toes, and mental retardation. Less frequently observed anomalies include cleft lip and palate, microcephaly, ocular defects, cardiovascular anomalies, hypospadias, umbilical and inguinal hernias, and significant developmental delays. Anaesthesia for incidental surgery in such a patient poses unique challenges for the anesthesiologist. We report the successful management of a 4-year-old male child with fetal hydantoin syndrome, cleft palate, spina bifida, atrial septal defect, and dextrocardia for tibialis anterior lengthening under subarachnoid block. Ranju Singh, Nishant Kumar, Sakshi Arora, Ritu Bhandari, and Aruna Jain Copyright © 2012 Ranju Singh et al. All rights reserved. Sat, 29 Sep 2012 13:30:52 +0000 http://www.hindawi.com/crim/anesthesiology/2012/281791/ Aim. To describe the subsequent treatment of airway trauma sustained during laryngoscopy and endotracheal intubation. Methods. A rare injury occurring during laryngoscopy and endotracheal intubation that resulted in perforation of the tongue by an endotracheal tube and the subsequent management of this unusual complication are discussed. A 65-year-old female with intraparenchymal brain hemorrhage with rapidly progressive neurologic deterioration had the airway secured prior to arrival at the referral institution. The endotracheal tube (ETT) was noted to have pierced through the base of the tongue and entered the trachea, and the patient underwent operative laryngoscopy to inspect the injury and the ETT was replaced by tracheostomy. Results. Laryngoscopy demonstrated the ETT to perforate the base of the tongue. The airway was secured with tracheostomy and the ETT was removed. Conclusions. A wide variety of complications resulting from direct and video-assisted laryngoscopy and tracheal intubation have been reported. Direct perforation of the tongue with an ETT and ability to ventilate and oxygenate subsequently is a rare injury. Loreto Lollo, Tanya K. Meyer, and Andreas Grabinsky Copyright © 2012 Loreto Lollo et al. All rights reserved. Sun, 16 Sep 2012 13:37:44 +0000 http://www.hindawi.com/crim/anesthesiology/2012/753875/ There is increasing evidence that children suffer from the consequences of spontaneous or iatrogenic intracranial hypotension. Pediatric epidural blood patch is gaining popularity because of its ability to alter cerebrospinal fluid dynamics and to alleviate headaches attributed to low cerebrospinal fluid pressure. There is, however, still not enough data to document the safety profile of an epidural blood patch. Here we describe a case of a fever in a child temporally related to the administration of an epidural blood patch. This case depicts the dilemmas in making the diagnosis and instituting treatment for complications of this procedure in the pediatric population. Agnes I. Hunyady, Corrie T. M. Anderson, John D. Kuratani, and Anjana Kundu Copyright © 2012 Agnes I. Hunyady et al. All rights reserved. Mon, 03 Sep 2012 11:45:23 +0000 http://www.hindawi.com/crim/anesthesiology/2012/349046/ Emery-Dreifuss muscular dystrophy (EDMD) is a hereditary neuromuscular disorder characterized by slowly progressive muscle weakness, early contractures, and dilated cardiomyopathy. We reported an uneventful general anaesthesia using total intravenous anaesthesia (TIVA) for cardiac transplantation in a 19-year-old woman suffering from EDMD. In vitro contracture test results of two pectoralis major muscle bundles of the patient suggest that exposition to triggering agents does not induce a pathological sarcoplasmic calcium release in the lamin A/C phenotype. However, due to the lack of evidence in the literature, we would recommend TIVA for patients with EDMD if general anaesthesia is required. Frank Schuster, Carsten Wessig, Christoph Schimmer, Stephan Johannsen, Marc Lazarus, Ivan Aleksic, Rainer Leyh, and Norbert Roewer Copyright © 2012 Frank Schuster et al. All rights reserved. Thu, 30 Aug 2012 17:49:20 +0000 http://www.hindawi.com/crim/anesthesiology/2012/297306/ Airway management of patients with very limited mouth opening remains a challenge for the anaesthetist. We describe the use of the Bonfils Intubation Fiberscope for awake intubation in two patients with a very limited mouth opening. In the first case, a 60-year-old 80 kg female, scheduled for a right modified radical mastectomy for infiltrating ductal carcinoma (15 mm mouth opening, a short thick neck, limited neck extension, and a Mallampati class 4 airway), the Bonfils was advanced via the retromolar technique. In the second patient, a 34-year-old male, scheduled for a surgical tracheotomy for right tonsillar cancer, due to a neoplastic infiltration of the right temporomandibular joint (7 mm mouth opening and limited neck movement), the Bonfils was advanced using the midline approach. The Bonfils is a reusable, rigid, straight fiberoptic device with a curved tip, is 5 mm in diameter, and has several advantages: it is quick and easy to use, more cost effective than a flexible fiberscope, and is safe in expert hands, thanks to its smaller diameter. Our conclusion is that awake BIF intubation is a reliable, atraumatic, and well-tolerated procedure to secure a safe airway in patients with a limited mouth opening. Nabil A. Shollik, Sami M. Ibrahim, Ahmed Ismael, Vanni Agnoletti, Emanuele Piraccini, and Ruggero Massimo Corso Copyright © 2012 Nabil A. Shollik et al. All rights reserved. Sun, 26 Aug 2012 19:24:37 +0000 http://www.hindawi.com/crim/anesthesiology/2012/407539/ A 52-year-old female presented with idiopathic stocking-glove neuropathy. She underwent a series of right and left stellate ganglion blocks with ropivacaine and clonidine, followed by lumbar sympathetic blocks. This resulted in complete symptom relief for two weeks. These procedures were repeated after a two-month interval; at that time she was still experiencing partial relief from the first series. She again remained completely pain free for several weeks following the injections. As the pain partially returned, daily oral clonidine was initiated and resulted in almost complete cessation of her symptoms, which persisted at a three-month follow-up examination. Jenna L. Walters, Daniel F. Lonergan, Robert D. Todd, and Tracy P. Jackson Copyright © 2012 Jenna L. Walters et al. All rights reserved. Wed, 22 Aug 2012 09:40:48 +0000 http://www.hindawi.com/crim/anesthesiology/2012/125346/ Horner’s syndrome results from paralysis of the ipsilateral sympathetic cervical chain (stellate ganglion) caused by surgery, drugs (mainly high concentrations of local anesthetics), local compression (hematoma or tumor), or inadequate perioperative positioning of the patient. It occurs in 100% of the patients with an interscalene block of the brachial plexus and can also occur in patients with other types of supraclavicular blocks.In this case report, we presented a case of Horner’s syndrome after performing an ultrasound-guided infraclavicular brachial plexus block with 15 mL of bupivacaine 0.5%. It appeared 40 minutes after the block with specific triad (ptosis, miosis, and exophtalmia) and quickly disappears within 2 hours and a half without any sequelae. Horner's syndrome may be described as an unpleasant side effect because it has no clinical consequences in itself. For this reason anesthesiologists should be aware of this syndrome, and if it occurs patients should be reassured and monitored closely. Trabelsi Walid, Belhaj Amor Mondher, Lebbi Mohamed Anis, and Ferjani Mustapha Copyright © 2012 Trabelsi Walid et al. All rights reserved. Thu, 16 Aug 2012 12:00:45 +0000 http://www.hindawi.com/crim/anesthesiology/2012/592198/ The elective surgical airway is the definitive management for a tracheal stenotic lesion that is not a candidate for tracheal resection, or who has failed multiple-tracheal dilations. This case report details the management of a patient who has failed an elective awake tracheostomy secondary to the inability to be intubated as well as severe scar tissue at the surgical site. A combination of regional anesthesia and venovenous bypass is used to facilitate the surgical airway management of this patient. Cerebral oximetry and a multidisciplinary team approach aid in early detection of an oxygenation issue, as well as the emergent intervention that preserved this patient’s life. Johnathan Gardes and Tracey Straker Copyright © 2012 Johnathan Gardes and Tracey Straker. All rights reserved. Thu, 16 Aug 2012 09:25:30 +0000 http://www.hindawi.com/crim/anesthesiology/2012/103051/ Serious cardiac complications occurring during noncardiac surgery in a young and otherwise normal person can be quite alarming for the anesthesiologist. We report here the case of a young, healthy woman who immediately after an uncomplicated spinal surgery developed a clinical picture suggestive of an acute myocardial infarction (MI) with positive relevant investigations. However, she had an abrupt and full clinical recovery and complete normalization of her cardiac investigations within a few days of this event and thereafter continued to lead a normal, symptom-free life unlike the usual course in an MI; her coronary angiography was also normal. A diagnosis of perioperative stress-induced cardiomyopathy or Takotsubo cardiomyopathy was subsequently made. This condition is characterized by a rapid, severe, but reversible, cardiac dysfunction triggered by physical or mental stress. Awareness of this entity should help anesthesiologists manage better this infrequent, but potentially life-threatening, perioperative complication. Pragati Ganjoo, Vijay K. Pandey, Hukum Singh, Monica S. Tandon, and Daljit Singh Copyright © 2012 Pragati Ganjoo et al. All rights reserved. Mon, 13 Aug 2012 15:12:53 +0000 http://www.hindawi.com/crim/anesthesiology/2012/648921/ A 98-year-old woman presented for a hemiarthroplasty of the left hip. Because of her age and cardiac and pulmonary co-existing diseases we decided to provide adequate regional anesthesia by continuous spinal anesthesia. Fragmented doses of isobaric bupivacaine 0.5% were administered through a system consisting of a spinal catheter connected to an antimicrobial filter. After an uneventful surgical procedure, prior to removal of the catheter, this system was flushed with 10 mL of normal saline in order to try to prevent post-dural-puncture headache. After arrival at the postanesthesia care unit and fifteen minutes after removal of the catheter the patient suffered an unexpected high thoracic sensory blockade and hypotension requiring treatment. The continuous spinal anesthesia technique can be used in selected cases to be able to administer local anesthetic agents in a slow and controlled manner to reach the desired effect. The risk of post-dural-puncture headache using this technique in elderly patients is very low and therefore precludes the need to try to prevent it. We have described a potentially dangerous complication of flushing a bupivacaine-filled system into the spinal canal of an elderly patient resulting in an undesirable high sensory blockade. R. Ketelaars and A. P. Wolff Copyright © 2012 R. Ketelaars and A. P. Wolff. All rights reserved. Thu, 05 Jul 2012 09:57:38 +0000 http://www.hindawi.com/crim/anesthesiology/2012/745939/ Posterior reversible encephalopathy syndrome (PRES) is a temporary condition that is diagnosed clinically, neurologically, and radiologically. Its symptoms vary, and nonspecific headaches, confusion, impairment of consciousness, nausea, vomiting, and visual impairment may occur. Acute hypertension often accompanies these symptoms. Patients can also suffer from convulsions, cortical visual impairment, and coma. Diagnosis can be difficult due to focal neurologic signs. Nevertheless, knowing the clinical risk factors can lead to the right diagnosis. It has been reported that this condition may also occur during organ transplantation, immunosuppressive treatment, and autoimmune diseases and chemotherapy, and also patients with eclampsia. In this paper, a 21-year-old, 31-week pregnant woman, who had been diagnosed with PRES and thanks to early diagnosis and treatment had fully recovered and discharged from the intensive care unit, is presented, and the relevant literature is discussed. Ismail Demirel, Ayse Belin Ozer, Mustafa K. Bayar, and Salih Burcin Kavak Copyright © 2012 Ismail Demirel et al. All rights reserved. Wed, 09 May 2012 15:08:31 +0000 http://www.hindawi.com/crim/anesthesiology/2012/753769/ A 41-year-old female patient with neurofibromatosis 1 presented with new neurologic deficits secondary to malignant degeneration of a tibial lesion. Ultrasound mapping of the popliteal nerve revealed changes consistent with an intraneural neurofibroma. Successful popliteal nerve blockade was achieved under ultrasound guidance. Arjun Desai, Brendan Carvalho, Jenna Hansen, and Jonay Hill Copyright © 2012 Arjun Desai et al. All rights reserved. Mon, 09 Apr 2012 10:51:07 +0000 http://www.hindawi.com/crim/anesthesiology/2012/107952/ We report a patient with myotonic dystrophy who showed prolonged rocuronium-induced neuromuscular blockade, although with a fast recovery with sugammadex. During general anesthesia with propofol and remifentanil, the times to spontaneous recovery of the first twitch (T1) of train of four to 10% of control values after an intubating dose of rocuronium 1 mg/kg and an additional dose of 0.2 mg/kg were 112 min and 62 min, respectively. Despite the high sensitivity to rocuronium, sugammadex 2 mg/kg administered at a T1 of 10% safely and effectively antagonized rocuronium-induced neuromuscular block in 90 s. Akihiro Kashiwai, Takahiro Suzuki, and Setsuro Ogawa Copyright © 2012 Akihiro Kashiwai et al. All rights reserved. Thu, 05 Apr 2012 15:55:37 +0000 http://www.hindawi.com/crim/anesthesiology/2012/801093/ We report a case of inability to ventilate a patient after completion of pneumonectomy, due to migrated tumor tissue to the contralateral side. This represents an unusual complication with a high mortality rate. We have managed to find the cause in time and were able to remove the obstructive tissue using bronchoscopy. S. E. Verstraeten, A. H. M. van Straten, H. H. M. Korsten, E. W. G. Weber, P. L. M. L. Wielders, and E. Berreklouw Copyright © 2012 S. E. Verstraeten et al. All rights reserved. Thu, 05 Apr 2012 15:54:52 +0000 http://www.hindawi.com/crim/anesthesiology/2012/109346/ The aim of the present paper is to report the anesthesia administration to a patient who was planned to undergo Heller myotomy for achalasia. There wasnot property in the patient whom allgrove syndrome was excepted any steroid treatment in preoperative period. The night before the operation 18 mg of prednisolone was administered intravenously. Induction of anesthesia was performed with thiopental sodium, vecuronium and fentanyl and the patient received endotracheal intubation. Eyes were taped closed and protected with ointment during surgery. Maintenance of anesthesia was achieved with 2% sevoflurane concentration in 50% O2-50% N2O. 25 mg of prednisolone was infused preoperatively, and intervention with insulin treatment was initiated when blood glucose level rose to 18 mmol/L at 2 hours. Safe anesthesia can be achieved by observing the preoperative development of tracheal aspiration, adrenal insufficiency and, autonomic dysfunction carefully and maintaining eye protection. Ayse B. Ozer, Omer L. Erhan, Cevdet Sumer, and Ozden Yildizhan Copyright © 2012 Ayse B. Ozer et al. All rights reserved.