Anesthesia for hemicolectomy in a known porphyric with cecal malignancy.

Intraoperative management of a known acute intermittent porphyria patient is a challenge requiring awareness of factors, which trigger an acute crisis, clinical features of a porphyric attack, knowledge of safe pharmacologic intervention, and preparedness for reintubation and ventilatory support. The classical signs of a porphyric crisis such as pain abdomen, vomiting and neuropsychiatric symptoms are masked under general anesthesia and can be confused with postoperative pain and vomiting and postoperative cognitive dysfunction, especially for intra-abdominal surgeries. Eternal vigilance for onset of an acute crisis is imperative. After a crisis of acute intermittent porphyria, residual paresis may persist for years in the absence of further attacks.

Management of tracheal stenosis: a report of two cases.

Two patients with post-ventilatory tracheal stenosis were treated by repeated dilatation with oesophageal dilators under general anaesthesia, and direct vision of the fiberoptic bronchoscope. The results of dilatations were remarkable and the patients continue to be asymptomatic after a follow up of more than two years.