An approach for safe conversion of an oral endotracheal tube to a nasal endotracheal tube.

We present an approach for safe management of a patient with an oral endotracheal tube who required conversion to a nasal endotracheal tube. A 35-year-old man presented for mandibular fracture repair after multiple injuries sustained in a motor vehicle accident. The patient already had an oral endotracheal tube, and the surgical team requested a nasal endotracheal tube to facilitate surgical exposure and postoperative airway management in anticipation of a wired jaw. A nasal endotracheal tube was inserted through the naris and a video laryngoscope was used to visualize the glottis. A tracheal tube introducer was inserted through the oral endotracheal tube, and the oral endotracheal tube was then withdrawn approximately 5 cm. The nasal endotracheal tube was advanced through the vocal cords alongside the tracheal tube introducer. The nasal endotracheal tube cuff was then inflated and the tracheal tube introducer was withdrawn.

Epidural analgesia complicated by dural ectasia in the Marfan syndrome.

Patients with the Marfan syndrome are considered to be high risk during pregnancy and warrant a complete multidisciplinary evaluation. One goal is to minimize hemodynamic fluctuations during labor since hypertensive episodes may result in aortic dissection or rupture. Although they may prevent these complications, neuraxial techniques may be complicated by dural ectasia. The case of a parturient with the Marfan syndrome and mild dural ectasia is presented. During attempted labor epidural placement, unintentional dural puncture occurred. A spinal catheter was used for adequate labor analgesia, and a resultant postdural puncture headache was alleviated by an epidural blood patch under fluoroscopic guidance.