Propofol extravasation in a breast cancer patient.

A breast cancer patient experienced an accidental propofol extravasation in the dorsum of her hand during a Port-A-Cath replacement. She had heavy pain which was treated with analgesics. The patient's hand was cooled and kept in an upright position. Three days later the patient received her last AC (adriamycin/cyclophosphamide) course without complications. Propofol extravasation did not result in tissue necrosis in this case. AC chemotherapy could be administered safely 3 days after propofol extravasation.

Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway.

Awake fibreoptic intubation is the gold standard for difficult airway management but failures are reported in the literature in up to 13% of cases. In case of failure, a tracheotomy is often indicated. We describe a novel technique for intubation in head and neck cancer patients with a difficult airway that we call awake fibrecapnic intubation. The aim of this study was to investigate the feasibility of this technique. We studied prospectively 15 consecutive intubations in head and neck cancer patients before diagnostic or therapeutic surgical procedures. After topical anaesthesia, a fibrescope was introduced into the pharynx. Spontaneous respiration was maintained in all patients. Through the suction channel of the fibrescope a special suction catheter was advanced into the airway for carbon dioxide measurements. When four capnograms were obtained, the fibrescope was railroaded over the catheter and after identification of tracheal rings, a tracheal tube was placed. Tracheal intubation was successful in all patients without bleeding or complications, with a median (range) time to intubation of 3 (2-15) min. Identification of the vocal cords and glottis was difficult in four patients due to extensive anatomical abnormalities or poor visibility; even in these patients, a capnogram was obtained within 4 s.