Usefulness of the WuScope to facilitate double-lumen endotracheal tube placement in a patient with ankylosing spondylitis.

Functional separation of the lungs may be accomplished by several methods. Patients with a stiff neck and limited mouth opening restrict options to a one-lung ventilation. We report the use of the WuScope video system, a new tool for facilitating double-lumen endotracheal tube placement for one-lung ventilation, in a patient who suffered from ankylosing spondylitis with a stiff, flexed neck and limited mouth opening for his recurrent spontaneous pneumothorax.

Spontaneous remission of left bundle branch block immediately after denitrogenation with inhalation of 100% oxygen prior to anesthetic induction.

Complete left bundle branch blocks have focused our attention, primarily because they are a sign predictive of mortality and a predictor of coexisting cardiovascular disease. Left bundle branch block (LBBB) is usually permanent but may occur transiently or intermittently. Spontaneous remission of LBBB rarely occurs during anesthesia. We present two patients in whom chronic LBBB reverted to normal sinus rhythm shortly following denitrogenation with inhalation of 100% oxygen during induction of anesthesia.

Neurological impairment following myocardial ischemia associated with postoperative epidural analgesia.

Although epidural analgesia reduces the postoperative stress response and provides good pain relief for patients, potential complications associated with the technique may decrease its acceptability for some patients. We describe a 76-year-old female who underwent surgery for carcinoma of the urinary tract. Postoperative epidural analgesia was performed at the postanesthesia care unit. Neither a repeat attempt nor accidental dural puncture was encountered during the procedure. Unfortunately, she sustained neurological impairment of the bilateral lower limbs following an episode of myocardial ischemia during the early postoperative period. When the neurological deficit was recognized following epidural anesthesia, poor puncture technique was the first to be blamed. In fact, a high level of sensory blockade could markedly decrease blood pressure and heart rate, particularly in the presence of hypovolemia, which might lead to impairment of coronary perfusion and result in myocardial ischemia. Severe systemic hypotension might further lead to hypoperfusion of the spinal cord, most possibly in the mid-thoracic region (T4 to T8) due largely to its relative hypovascularity. Therefore, we recommend that maintaining sufficient circulatory volume of the patient, evaluating and recording the neurological function of the patient and determining the possible risk factors associated with coronary arterial disease are imperative prior to performing an epidural procedure.

Folding of the epiglottis - an unusual complication to be recognized after laryngoscopic endotracheal intubation.

We report a case of folding of the epiglottis during endotracheal intubation, an unusual complication of intubation. A 36-year-old female patient underwent laryngeal microsurgery for a vocal polyp. Following anesthesia induction, an endotracheal tube (ID = 6.0 mm, cuffed) was advanced through an intubating laryngoscope via the oropharyngeal route. At the beginning of the surgery, the otolaryngologist noted that the patient's epiglottis was folded under the view of the surgical laryngoscopy. The endotracheal tube was adjusted immediately by withdrawing it 0.5 cm with the cuff deflated. Slight edema of the upper ridge of the epiglottis was noted. There were no sequelae such as laryngeal spasm or vocal cord palsy after the surgery. The "peardrop" phenomenon is suggested as a possible cause of this event. Potential adverse outcomes of this unusual occurrence are reviewed.