Anesthetic management in a challenging case of primary pulmonary synovial sarcoma

Primary pulmonary synovial sarcoma is a very rare tumor. This tumor accounts for less than 0.5% of all lung neoplasia. While synovial sarcomas are commonly reported from periarticular tissues, they are often found in lung or thorax as a metastasis from an extrapulmonary primary. However, rarely they arise primarily from lung tissue. We report a case of primary pulmonary synovial sarcoma which was indenting the right side of the heart. He was managed with neoadjuvant chemotherapy followed by surgical resection. The anesthetic management was challenging. The focus was kept on stringent invasive as well as non-invasive monitoring of cardiac and respiratory parameters. The surgery was uneventful and the patient made a successful recovery.

Robotic intraoperative tracheal repair during retrosternal malignant goiter excision: an anesthetic challenge

Thyroidectomy is the treatment of choice for large retrosternal goiters. These tumors often are large enough to require thoracotomy. Robotic surgery can help in avoiding thoracotomy and its associated post operative complications. Rarely, such tumors and their surgery can be complicated by tracheal tears. Such tears, especially those near the carina are difficult to repair and often require open thoracotomy. We described such a case where we avoided open thoracotomy and instead performed a minimally invasive robotic repair of tracheal tear. The maintenance of ventilation during this robotic repair was critical. A combination of several airway devices was used to allow the complex surgical repair to be executed without affecting ventilation

Ball valving laryngeal masses: a difficult “ball” in the anaesthetists’ court

Dynamic airway obstruction (also called ball-valve effect) is a serious condition often seen in glottic lesions. This is an anesthetic challenge as total airway obstruction can occur after the induction of general anesthesia. We present a case of a middle aged female who had a large laryngeal mass which was showing ball-valve effect. The patient had refused for tracheostomy despite it being the safest procedure in the circumstances. We then performed videolaryngoscopy and managed to intubate the patient with the help of some improvisation. The patient underwent a succesful and uneventful surgery

Stellate ganglion pulsed radiofrequency ablation for stretch induced complex regional pain syndrome type II

Complex regional pain syndrome (CRPS) following injury or nerve damage, as its name signifies, is a challenging entity, and its successful management requires a multidisciplinary approach. It not only manifests as severe pain, but also gives rise to functional disability, lack of sleep, lack of enjoyment of life and poor quality of life. Various pain interventional techniques have been described in the literature for the management of CRPS ranging from sympathetic blocks to spinal cord stimulator. A 34-year-old liver transplant donor, who developed position-induced right upper limb neuropathic pain suggestive of CRPS type II was managed initially with medications and later with stellate ganglion block under fluoroscopic guidance at cervical C7 position. Following an initial significant improvement in pain and allodynia, which was transient, a pulsed radiofrequency ablation of stellate ganglion was performed successfully to provide prolonged and sustained pain relief, which persisted up to 14 months of follow-up