“Spray-as-you-go” medical technique for awake intubation using a combination of an epidural catheter and the OptiScope in a patient with Ludwig's angina: A case report

A 73-year-old woman presented to the emergency department with submandibular pain and swelling. The patient was diagnosed to have Ludwig's angina, and she was planned to undergo urgent incision and drainage under general anesthesia. However, her physical examination revealed severe diffuse swelling extending from the bilateral submandibular spaces to the submental space and further down to the neck. As our view was blocked by the patient's neck swelling, we did not perform a regional anesthesia of the airway or a transtracheal block. Several non-invasive alternatives were considered. The “spray-as-you-go” technique was chosen, and it was performed using the OptiScope®. However, the OptiScope did not have a working channel or syringe adaptor for the administration of the local anesthetic solution. To solve this problem, we combined the OptiScope with a 27-G tunneled epidural catheter (100 cm) for the administration of lidocaine and this combination made the awake intubation successful.

Secondary Erythromelalgia: A Case Report

Erythromelalgia is a rare neurovascular pain syndrome characterized by a triad of redness, increased temperature, and burning pain primarily in the extremities. Erythromelalgia can present as a primary or secondary form, and secondary erythromelalgia associated with a myeloproliferative disease such as essential thrombocythemia often responds dramatically to aspirin therapy, as in the present case. Herein, we describe a typical case of a 48-year-old woman with secondary erythromelalgia linked to essential thrombocythemia in the unilateral hand. As this case demonstrates, detecting and visualizing the hyperthermal area through infrared thermography of an erythromelalgic patient can assist in diagnosing the patient, assessing the therapeutic results, and understanding the disease course of erythromelalgia.

Significance of Infrared Thermal Imaging in Herpes Zoster Patients / 대한마취과학회지

BACKGROUND: Herpetic disorders cause pain and skin lesion. So, asymmetric temperature of both sides of the involving dermatome has been reported in thermogram. This study examined the usefulness of infrared thermography for a predictor of post-herpetic neuralgia (PHN). METHODS: Patients with acute herpes zoster who underwent nerve block were randomly selected. Biographic data, including age, gender and times of onset of the skin lesions, development of PHN, combined diseases were recorded. Infrared thermography was performed and subjective pain severity, dysesthesia and allodynia, skin lesion size were assessed. RESULTS: The temperature differences between the lesion site and the contralateral site at lateral and posterior were significantly correlated with lesion size (P 0.05). PHN was correlated with skin lesion size and infrared thermal imaging (P < 0.01). CONCLUSIONS: Infrared thermal imaging cannot demonstrate subjective pain objectively in herpes zoster. Short duration showed high temperature on the lesion sites compared to the contralateral sites. The patients with big skin lesions developed PHN more. The PHN can be predicted by the infrared thermal imaging as low temperature on the lesion site compared to the contralateral site.