Anesthetic Implications of Previously Undiagnosed Temporomandibular Joint Ankylosis: A Case Report.

Temporomandibular joint (TMJ) ankylosis is characterized by bony fusion that limits TMJ mobility. We present the case of an elderly woman who was brought to the operating room for dental rehabilitation under general anesthesia. The patient had an undiagnosed TMJ ankylosis, which was discovered only after induction of anesthesia due to her nonverbal status and advanced dementia. The surgical team canceled the case due to limited access to the surgical field. We discuss the factors that suggest TMJ ankylosis and propose the perioperative management when TMJ ankylosis is suspected but unconfirmed.

Intraoperative Diagnosis of "Bronchus Suis", a Variant of Tracheal Bronchus.

Bronchus suis, also known as tracheal bronchus, is a rare congenital anatomic variant in which an aberrant bronchus develops above the carina. Often asymptomatic, bronchus suis may be detected during imaging or manipulation of the airway. Here we describe a case where bronchus suis was visualized by fiberoptic bronchoscopy performed intraoperatively for the evaluation of desaturation and management of endotracheal secretions. It is important for anesthesiologists to consider the possibility of tracheal bronchus in patients with acute respiratory compromise.

Dose Comparison of Dexmedetomidine Sedation following Spinal Anesthesia: Parturient versus Nonpregnant Women-A Randomized Trial.

BACKGROUND: This study was designed to investigate and compare the effective doses of dexmedetomidine for sedation in parturient patients who underwent Cesarean section (CS) and nonpregnant women who underwent elective gynecologic surgery. METHODS: The study comprised 60 females aged between 25 and 35. They were divided into two groups. The parturient group received a bolus dose of dexmedetomidine over 15 min after the delivery of the fetus and placenta. In the nonpregnant women group, a bolus of dexmedetomidine was administered intravenously upon the completion of spinal anesthesia. The subsequent dose required by patients in each group was then determined through a modified two-stage Dixon up-and-down sequential method. Probit analysis was used to calculate the ED50 and the ED95 of dexmedetomidine for adequate sedation. RESULTS: The ED50 of dexmedetomidine for adequate sedation in parturient patients was 1.58 µg/kg (1.51-1.66 µg/kg); in nonpregnant women, it was 0.96 µg/kg (0.91-1.01 µg/kg) (95% CI). The ED95 of dexmedetomidine in parturients was 1.80 µg/kg (1.70-2.16) µg/kg and that of nonpregnant women was 1.10 µg/kg (1.04-1.30 µg/kg) (95% CI). The ED50 in parturients was significantly higher than that in nonpregnant women (P < 0.05). CONCLUSION: The ED50 of dexmedetomidine for target sedation in parturients who received spinal anesthesia for CS is greater than 1.5 times that in nonpregnant women who received spinal anesthesia for lower abdominal gynecologic surgery. This study postulates that the dose of dexmedetomidine required to achieve optimal sedation following spinal anesthesia is much higher in parturients than in nonpregnant women undergoing gynecologic surgeries. This trial is registered with NCT02111421.

Kratom, an Emerging Drug of Abuse: A Case Report of Overdose and Management of Withdrawal.

Kratom is an herb indigenous to Southeast Asia with psychoactive opioid compounds, often used as a treatment for chronic pain or opiate withdrawal symptoms. It is legally and readily available via Internet sales and has been identified as an emerging drug of abuse in the United States. Kratom use has been associated with psychosis, seizures, and even death. At lower doses, kratom acts as a stimulant, while at higher doses, it produces analgesia and euphoria. Here, we describe the successful management of kratom overdose and withdrawal in a young man with negative toxicology screens.