Fiberoptic-guided nasotracheal intubation under conscious sedation with dexmedetomidine on a patient with giant ameloblastoma scheduled for mandibulectomy

This is a case of a 54 year old ASA III mle who underwent extirpation of recurrent multiseptated mandibular ameloblastoma; with microvascular fibul free flap reconstruction. the extension of the huge mass into the floor of the mouth and anteriorly into the sub-metal area indicating probable difficult instrumentation during laryngoscopy, necessitated awake fiberoptic guided nasotracheal intubation using dexmedetomidine sedation. Anesthesia was maintained with oxigen- isoflurane at 0.8-1.5 volue percent, atracurium infusion at 0.2 mg/kg/ hour, fetanyl infusion at 1-2 mcg/kg/hour. Postoperatively, the patient remained intubated for 7 days.

An illicit-substance-using patient undergoing arthroscopic shoulder reconstruction with continuous interscalene brachial plexus blockade as primary anesthetic technique and dexmedetomidine as sedating agent

This is the case of a 22-year-old male student actively involved in mixed martial arts (MMA) with a history od recurrent dislocation of both shoulder joints since he was 16 years old; most recent of which is twisting of his right shoulder one month prior to admission. Personal history revealed two years regular use of illicit substances such as marijuana and methamphetamine as well as the non-medical use of oral diazepam and intramuscular meperidine. He subsequently underwent arthroscopic right shoulder reconstruction in the beach chair position under continuous interscalene brachail plexus block with dexmedetomidine infusion for sedation.

Cerebello-pontine angle meningioma in 29 year-old pregnant patient

Primary brain tumor and pregnancy rarely occur together .Meningioma and pregnancy mre rarely do. This is a case of 29-years-old woman, diagnosed with cerebello-pontinenge meningioma who underwent cesarean section on the 35th weeks of pregnancy. The perioperative period was uneventful. this case demonstrate balanced anesthesia with low MAC Sevoflurane plus propofol infusion with adition of analgesics, Tramadol and Diclofenac that offers a reasonably adequate anesthetic level that can prevent increases in maternal intracranial pressure prioperatively without deleterious effect to the fetus and the uterus. It is emphasized that continuous and vigilant monitoring of the mother and fetus is essential.