Foreign body removal with repair of iatrogenic tracheo-bronchial tear repair: An anesthetic challenge

Foreign body aspiration into the airway is common in the pediatric age group and its anesthetic management is a challenge. Iatrogenic tracheo-bronchial injury further worsens the situation. Flexible pediatric fiberscope is the gold standard for securing the airway in cases of airway injury. We present a case of a 7-year-old girl who presented to the hospital with signs and symptoms of foreign body aspiration and suspected tracheo-bronchial tree injury. The impacted foreign body was removed by rigid bronchoscopy and the presence of a tracheo-bronchial tear was confirmed. To repair the airway tear, thoracotomy was planned necessitating one lung ventilation. A pediatric flexible fiberscope was not available, so left endobronchial intubation for one lung ventilation was done with the help of an airway exchange catheter using a rigid bronchoscope as a conduit. Subsequent intra-operative and post-operative period were uneventful

Conventional radiofrequency ablation of sphenopalatine ganglion for the treatment of cluster headache

Cluster headache is a primary neurovascular unilateral headache associated with autonomic symptoms. The sphenopalatine ganglion plays an important role in the pathogenesis of this disorder. Although medications are the first line of treatment, percutaneous, and surgical interventions have been proposed to treat cluster headache. An attractive option is the radiofrequency ablation of the sphenopalatine ganglion for the treatment of cluster headache due to its relative safety and simplicity compared with other procedures

Donepezil: A cause of inadequate muscle relaxation and delayed neuromuscular recovery

A 74-year-old female with diabetes mellitus type II and Alzheimer's disease, taking donepezil for 4 months was operated for right modified radical mastectomy under general anesthesia. During the procedure a higher dose of non-depolarizing muscle relaxant was required than those recommended for her age yet the muscle relaxation was inadequate intra-operatively. Residual neuromuscular blockade persisted postoperatively, due to the cumulative effect of large doses of non-depolarizing muscle relaxant, needing post-operative ventilatory assistance. After ruling out other causes of resistance to non-depolarizing muscle relaxants, we concluded that acetylcholinesterase inhibitor donepezil was primarily responsible for inadequate muscle relaxation and delayed post-operative neuromuscular recovery