Near total airway obstruction due to tracheal granulations: an anesthesiologist's nightmare

A 17 year old boy, post tracheoplasty, presented to emergency in respiratory distress with presence of stridor at rest. Flexible bronchoscopy revealed granulations at tracheal graft site causing airway stenosis. The presence of graft perculded use of invasive surgical approaches due to risk of damage.The anesthetic management options in this case carried inherent risks of causing total airway obstruction and impairing surgical access. We decided to perform the electrocauterization of tracheal granulations using subglottic jet ventilation while placing the catheter above the stenotic trachea

Depression masquerading as chest pain in a patient with Wolff Parkinson White syndrome

Wolff Parkinson White (WPW) syndrome is a condition in which there is an aberrant conduction pathway between the atria and ventricles, resulting in tachycardia. A 42-year-old patient, who was treated for WPW syndrome previously, presented with chronic somatic pain. With her cardiac condition in mind, she was thoroughly worked up for a recurrence of disease. As part of routine screening of all patients at our pain clinic, she was found to have severe depression as per the Patient Health Questionnaire–9 (PHQ–9) criteria. After ruling out sinister causes, she was treated for depression using oral Duloxetine and counselling. This led to resolution of symptoms, and improved her mood and functional capability. This case highlights the use of psychological screening tools and diligent examination in scenarios as confusing as the one presented here. Addressing the psychological aspects of pain and adopting a holistic approach are as important as treatment of the primary pathology.

Depression masquerading as chest pain in a patient with Wolff Parkinson White syndrome

Wolff Parkinson White (WPW) syndrome is a condition in which there is an aberrant conduction pathway between the atria and ventricles, resulting in tachycardia. A 42-year-old patient, who was treated for WPW syndrome previously, presented with chronic somatic pain. With her cardiac condition in mind, she was thoroughly worked up for a recurrence of disease. As part of routine screening of all patients at our pain clinic, she was found to have severe depression as per the Patient Health Questionnaire–9 (PHQ–9) criteria. After ruling out sinister causes, she was treated for depression using oral Duloxetine and counselling. This led to resolution of symptoms, and improved her mood and functional capability. This case highlights the use of psychological screening tools and diligent examination in scenarios as confusing as the one presented here. Addressing the psychological aspects of pain and adopting a holistic approach are as important as treatment of the primary pathology.