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A 25-year-old man underwent an excision of a thigh mass under general anesthesia without any complication. After the operation, he developed oxygen desaturation requiring a jaw thrust maneuver. A rapidly expanding hematoma on the right side of the neck was formed shortly after the application of the maneuver. The patient was returned to the operation room for a neck exploration. Damage to the facial artery and vein was noted. Further evaluations confirmed the diagnosis of Neurofibromatosis type 1 (NF-1). It is recommended that considering the probable risk of arising hematoma in NF-1 patients, application of jaw thrust maneuver should be performed meticulously.

Background: Spinal anesthesia is an important and commonly used method for surgical anesthetic in operating rooms. However, even with identical drug dosage and administration mode, the extent of drug distribution in vivo is highly variable and difficult to control. Preanesthetic administration of fluids immediately before spinal anesthesia (preload) is normal practice. The choice of fluid type may affect drug distribution as well as the duration and level of the block. Objectives: We examined whether preloads of normal saline, Ringer, or hydroxyethyl starch has different effects on the time it takes to reach maximum block, and the distribution and duration of spinal block level. Patients and Methods: This was a randomized trial and the 150 patients selected were evenly divided into three groups and given; normal saline, Ringer, or hydroxyethyl starch 130/0.4f luids. Preload was given at 10 mL/kg for the normal saline and Ringer groups, and 5 mL/kg for the hydroxyethyl starch group, 10 min before the spinal anesthesia. Sensory block levels were recorded every 5 min until 30 min after spinal anesthesia and then at 60 and 90 min. Time taken to reach maximum and median sensory block, maximum and median level of block, duration of block, and hemodynamic status were recorded. Results: There were no statistically significant differences in the demographic characteristics between the three groups. Maximum block was higher in normal saline compared to Ringer (P = 0.029). Time taken to reach maximum block was greater in Ringer compared to both normal saline (P = 0.001) and hydroxyethyl starch (P = 0.003). Normal saline had a longer duration of sensory block T10 compared to Ringer and hydroxyethyl starch (P = 0.03). Conclusions: Preload fluids have an impact on the level, distribution and duration of sensory block in spinal block. Of the three fluids, normal saline produced the greatest maximum and longest duration of block, whereas time taken to reach maximum block was longer in the Ringer group.

In this report, we present a case of death caused by a broken ETT. Our patient (male) was a 32-year-old, with a known case of Hodgkin's lymphoma of eight years duration, prior to admission to our infectious disease department (Imam Hosein Medical Center, Tehran, Iran) with fever, cachexia, and dyspnea. Antibiotic treatment (imipenem, vancomycin) was started with a diagnosis of pneumonia. After 48 hours from the admission, the patient was transferred to the ICU because of his decreased level of consciousness, and intubation was ordered. When visited by an anesthesiologist, the patient was confused, cachectic, sweating, and suffering from respiratory distress. Vital signs were recorded as follows: PR = 110 /min, RR = 40/min, axillary temperature = 38°C, and blood pressure = 90/50 mmHg. In lung auscultation, the breathing sounds were muffled in the left superior and middle lobes, and coarse crackles were heard in the lung bases. Arterial blood gas analysis results were: pH = 7.18, HCO3 = 15 mmol/L, PCO2 = 23 mmHg, PO2 = 48 mmHg, BE = -8 mmol/L O 2 , and saturation = 85%. Considering the patient’s condition, cardiorespiratory monitoring and pulse oximetry were established. After suctioning the oral secretions, an intravenous injection of 150 µg fentanyl and 80 mg lidocaine 2%, plus four puffs of lidocaine 10%, were administered to anesthe tize the glossopharyngeal nerve and a direct laryngoscopy was carried out. Then, the patient was intubated with a high volume low-pressure tracheal tube No 8, with an inflated cuff. After the correct position of tube was con firmed, the cuff was filled with 5cc air. Mechanical ventilation was established in the synchronized intermittent mandatory ventilation (SIMV) mode with pressure support parameters as follows: RR = 12/ min, TV = 450 cc, PEEP = 3 cm H 2 O, pressure support = 15 cm H 2 O, flow trigger = 2 L/min, inspiratory time = 1.5 sec, inspiratory flow rate = 50 L/min, and FIO 2 = 100%.