We present a patient who experienced airway obstruction during an elective esophagogastroduodenoscopy (EGD) under anesthesia secondary to previously undiagnosed tracheomalacia. Physiology of airway obstruction with forced breathing maneuvers is discussed along with the potential advantages of dexmedetomidine-ketamine sedation for management of patients with achalasia undergoing outpatient endoscopic procedures.

Joshua H. Atkins

Jeff E. Mandel

David C. Metz

Sudden Tracheal Collapse during EGD and Subsequent Anesthetic Management with Dexmedetomidine-Ketamine in a Patient with Achalasia and Tracheomalacia

We report a case of accidental subcutaneous infusion of remifentanil as a cause of delayed awakening after a craniotomy.

Alexander Wolfson

Cephas Swamidoss

Accidental Subcutaneous Remifentanil Infusion as a Cause of Delayed Awakening after Craniotomy

A fractured central venous catheter (CVC) with embolization of the distal fragment may lead to life-threatening complications. We had inserted a right subclavian CVC in a 68-year-old female which upon a follow-up chest X-ray appeared to have been sheared. A guidewire was inserted through the CVC until the J-tip was just beyond the tip of the CVC which were then withdrawn as a single assembly. We suspected that the tip of the guidewire might have been entrapped in the opening of the middle port, which upon withdrawal of the guidewire could have led to CVC folding upon itself and shearing.

Harihar V. Hegde

Vijay G. Yaliwal

Shyamsundar K. Joshi

P. Raghavendra Rao

The Sheared Central Venous Catheter?

Dental trauma during tracheal intubation mostly happens in case of poor dentition, restricted mouth opening, and/or difficult laryngoscopy. 57-year-old man undergoing laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma had his dental work detached at induction of anesthesia. Oropharyngeal direct view, manual inspection, fibreoptic nosendoscopy, tracheobronchoscopy, and fiberoptic inspection of the esophagus and stomach were unsuccessful in locating the dislodged bridge. While other possible exams were considered, such as lateral and AP x-ray of head and neck, further meticulous manual &#8220;sweepings&#8221; of the mouth were performed, and by moving the first and second fingers below the soft palate deep towards the posterolateral wall of the pharynx, feeling consistent with a dental prosthesis was detected in the right pharyngeal recess. Only after pulling the palatopharyngeal arch upward was it possible to grasp it and extract it out with the aid of a Magill Catheter Forceps. Even though the preexisting root and bridge deficits were well reported by the consultant dentist, the patient was fully reimbursed. The lack of appropriate documentation of the advanced periodontal disease in the anesthesia records, no mention of potential risks on anesthesia consent, and insufficient protective measures during airway instrumentation reinforced the reimbursement claim.

Paolo Feltracco

Stefania Barbieri

Francesca Salvaterra

Letizia Tiano

Rosa Maria Gaudio

Helmut Galligioni

Carlo Ori

Francesco Maria Avato

Unusual Displacement of a Mobilised Dental Bridge during Orotracheal Intubation

Spinal muscular atrophy (SMA) is a rare genetic disease characterized by degeneration of spinal cord motor neurons, which results in hypotonia and muscle weakness. Patients with type IV SMA often have onset of weakness from adulthood. Anesthetic management is often difficult in these patients as a result of muscle weakness and hypersensitivity to neuromuscular blocking agents as shown by (Lunn and Wang; 2008, Simic; 2008, and Cifuentes-Diaz et al.; 2002).  Herein we report a case of anesthetic management of a patient with SMA type IV for mammectomy and review some other cases of SMA patients receiving different kinds of anesthesia.

Xiu-Fen Liu

Dong-Xin Wang

Daqing Ma

Using General Anesthesia plus Muscle Relaxant in a Patient with Spinal Muscular Atrophy Type IV: A Case Report

Introduction. Caesarean section is the commonest operation carried out in females of the reproductive age group. Spinal anaesthesia is commonly used for caesarean section with its risk. Permanent paralysis of the lower limbs following subarachnoid block is a rare complication but can occur even in the best of hands. Case Summary. This is a 29-year-old final-year university student now 34 years old who had emergency caesarean section for cephalopelvic disproportion in 2005 under spinal anaesthesia in a low-resource setting in a developing country. She developed permanent neurological deficit thereafter. She had urinary and faecal incontinence for one year. She lost one academic session at her school because of long hospital stay and is now confined to a wheel chair. She celebrated her daughter's fifth birthday in October, 2010. Although there is ability in inability, she is now disabled. Conclusion. It is important for clinicians to recognise the complications of subarachnoid block promptly to avoid delay in treatment and severe neurological deficits.

Yvonne Dabota Buowari

Quality of Life Following Permanent Neurological Damage after Subarachnoid Block

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Case Reports in Anesthesiology publishes case reports and case series related to anesthetic administration and efficacy, preoperative and postoperative considerations, perioperative care, critical care etc.

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Case Reports in Anesthesiology - Table of contents 2011

title

Case Reports in Anesthesiology publishes case reports and case series related to anesthetic administration and efficacy, preoperative and postoperative considerations, perioperative care, critical care etc.

Case Reports in Anesthesiology