Airway Management During Anesthetic Induction of Secondary Laryngectomy for Recurrent Laryngeal Cancer: Three Cases of Report and Analysis

Surgery for laryngeal cancer and the following recurrent tumor growth may further change the anatomy of the airway. Airway management during anesthesia induction is challenging for the patients undergoing secondary surgery due to recurrence of laryngeal cancer or its postoperative complication, but it has never been reported. In this report, we described three cases of anesthetic induction which had different process of airway events. The first case was given intravenous general anesthetic for induction and experienced failed intubation, difficult mask ventilation and emergent tracheostomy, eventually were rescued successfully. The second case presented a fixed metastatic mass about 6 cm diameter upon the primary surgical scar of incision and preoperative apnea, underwent fibroscopy-guided conscious intubation and the process was uneventful. The third case had erythema and swelling under the mandible with erupted ulcer as well as neck immobility due to recurrent tumor. The anesthesiologist attempted fibroscopy-guided intubation via nasal passage with a tracheal tube in 2.8 mm diameter but it was failed. Subsequently, tracheostomy was performed under bilateral superficial cervical plexus block and the dissected larynx by operation verified distorted structure of glottis with S-shaped stenosis. This report concludes that, during the anesthetic induction for this special type of surgery, a detailed and comprehensive evaluation of the airway, and a routine fibroscopic examination are especially important

From Bad to Worse: Paraganglioma Diagnosis during Induction of Labor for Coexisting Preeclampsia

Pheochromocytomas and extra-adrenal paragangliomas are catecholamine-secreting tumors that rarely occur in pregnancy. The diagnosis of these tumors in pregnancy can be challenging given that many of the signs and symptoms are commonly attributed to preeclampsia or other more common diagnoses. Early diagnosis and appropriate management are essential in optimizing maternal and fetal outcomes. We report a rare case of a catecholamine-secreting tumor in which diagnosis occurring at the time labor was being induced for concomitant preeclampsia with severe features. Her initial presentation in hypertensive crisis with other symptoms led to diagnostic workup for secondary causes of hypertension and led to eventual diagnosis of paraganglioma. Obtaining this diagnosis prior to delivery was essential, as this led to prompt multidisciplinary care, changed the course of her clinical management, and ultimately enabled good maternal and fetal outcomes. This case highlights the importance of maintaining a high index of suspicion for secondary causes of hypertension and in obstetric patients and providing timely multidisciplinary care