Metallic microbeads for hair extensions: Hidden dangers for magnetic resonance imaging.

Metallic foreign objects can cause various thermal injuries in patients undergoing magnetic resonance imaging (MRI). We present a case of a 33-year-old woman with numerous metallic microbeads on her head used for attaching hair extensions, who required MRI of her cervical spine under anesthesia. Due to the nature of how these microbeads were attached, as well as the quantity and configuration, these objects were determined to be a significant risk, especially for a patient requiring anesthesia for their scan. To our knowledge, this is the first report in literature of a patient presenting with such objects for MRI. Awareness of the implications of these microbeads on patient safety and recognizing the importance of a thorough safety screening process can enhance care for patients requiring MRI.

Retromolar fibreoptic orotracheal intubation in a patient with severe trismus undergoing nasal surgery.

PURPOSE: A considerable challenge arises when passage of an endotracheal tube between the teeth is impossible because of severe trismus and the presence of concomitant contraindications to nasotracheal intubation. We report a novel technique to circumvent the need for tracheostomy by using the retromolar space for oral fibreoptic intubation. CLINICAL FEATURES: A 50-yr-old female with a history of pharyngeal cancers treated with surgery and radiotherapy presented for right dacryocystorhinostomy. She had undergone left dacryocystorhinostomy after nasotracheal intubation one week earlier. This time, orotracheal intubation was requested since surgery would involve the right nostril and left nasal intubation might dislodge the recently placed nasolacrimal tube. Due to severe trismus, the patient's interincisor distance was only 9 mm, and it was impossible to pass a 6.0 mm endotracheal tube through that gap. A flexible bronchoscope loaded with a 6.0 mm tracheal tube was inserted through the retromolar space into the pharynx and maneuvered through the vocal cords for endotracheal intubation. CONCLUSIONS: The retromolar space is located between the last molar and the ascending ramus of the mandible. Even with complete mandibular occlusion, it is usually able to accommodate a 7.0 mm endotracheal tube. Despite its hidden location, it can be used successfully for orotracheal fibreoptic intubation. With practice, the expertise achieved in performing this technique will confer a much needed option for securing the airway in this challenging situation.

Successful Verbal Communication Using Google Translate to Facilitate Awake Intubation of a Patient With a Language Barrier: A Case Report.

Perioperative difficult airway management is one of the most challenging tasks encountered by anesthesiologists. Awake intubation is considered the gold standard in securing the anticipated difficult airway. Effective communication between the anesthesiologist and patient is vital during awake intubation. A language barrier can significantly hinder success and jeopardize patient safety. We report a case of a monolingual Arabic-speaking patient with a difficult airway who required awake intubation to undergo surgery. Google Translate, a free and accessible translation software application, was used during his awake intubation-we recommend such an approach to be considered to reduce anxiety and facilitate success by providing concise, real-time instruction in the patient's preferred language.

Securing the Airway in Pretracheal Dermal Metastases From Oropharyngeal Carcinoma: A Case Report.

Dermal metastases reflect the ominous and aggressive spread of oropharyngeal squamous cell carcinomas. The rampant proliferation of these metastatic tumors to the neck results in respiratory distress and impending airway obstruction. We report a case of a patient with massive neck dermal metastases requiring urgent airway control for intermittent stridor. Awake tracheostomy is generally regarded as the gold standard to manage the compromised airway. However, in this unusual case, after discussion between surgeon and anesthesiologist, because of the anticipated formidable difficulties in performing awake tracheostomy, it was decided that awake fiberoptic intubation would provide the best chance of success.

Recurrent intraoperative coronary artery spasm in a patient with coronary artery aneurysm.

Coronary artery spasm (CAS) may result from endothelial dysfunction in nonobstructed arteries. Its complications include myocardial infarction, dysrhythmias, and death. It is difficult to diagnose CAS during general anesthesia because it closely mimics obstructive ischemia. We report the case of a patient who demonstrated intraoperative CAS during two separate surgeries. Angiography after the first surgery showed nonobstructed coronary anatomy. During the second surgery, recurrence of acute ST elevations caused by CAS rapidly responded to nitroglycerin. A high index of suspicion for CAS as a cause of intraoperative ischemia is necessary for an early diagnosis, treatment, and a favorable outcome.

Do Not Burn Your Airway Bridge: A Technique to Safely Exchange a Tracheostomy Tube for a Tracheal Tube.

Tracheostomy is one of the most ancient and commonly performed surgical procedures. When tracheostomized patients require a subsequent intervention, it is usually necessary to exchange the tracheostomy tube for a tracheal tube, which can be dangerous. These potential complications may be overlooked or underestimated by the anesthesia providers. An inability to ventilate the patient and replace the tube after removal of a fresh tracheostomy tube can escalate rapidly to a life-threatening crisis. We present a case in which an airway exchange catheter was used to safely replace a tracheostomy tube with a tracheal tube in a patient with a fresh tracheostomy.

Orotracheal Intubation Using the Retromolar Space: A Reliable Alternative Intubation Approach to Prevent Dental Injury.

Despite recent advances in airway management, perianesthetic dental injury remains one of the most common anesthesia-related adverse events and cause for malpractice litigation against anesthesia providers. Recommended precautions for prevention of dental damage may not always be effective because these techniques involve contact and pressure exerted on vulnerable teeth. We describe a novel approach using the retromolar space to insert a flexible fiberscope for tracheal tube placement as a reliable method to achieve atraumatic tracheal intubation. Written consent for publication has been obtained from the patient.

Measurement of retromolar space dimensions using dental pantomograms for intubation feasibility.

BACKGROUND: The purpose of this study was to measure the dimensions of the retromolar space of a patient population. If the dimensions were found to exceed the outside diameters of commonly used tracheal tubes, the results could increase use of the retromolar approach for oral intubation in patients with trismus. METHODS: We reviewed 311 dental pantomograms. Retromolar space height was measured from the lowest point of the maxillary tuberosity to the mandibular alveolar ridge. Width was measured from the last mandibular molar to the junction of the anterior border of the ramus with the body of the mandible. RESULTS: Mean height and width were 17.87 mm and 17.48 mm for the right space and 18.07 mm and 16.51 mm for the left. CONCLUSION: These dimensions were usually larger than the outside diameters of commonly used tracheal tubes. The retromolar approach can be considered an option for flexible fiberoptic intubation in patients with trismus. © 2015 Wiley Periodicals, Inc. Head Neck 38: E638-E642, 2016.

Intraoperative opioids use for laryngeal squamous cell carcinoma surgery and recurrence: a retrospective study.

STUDY OBJECTIVE: To assess whether the use of intraoperative opioids is associated with poor recurrence-free survival (RFS) and overall survival (OS) after lung cancer surgery. DESIGN: Retrospective study. SETTING: Academic hospital. SUBJECTS: Patients with laryngeal primary or recurrent laryngeal squamous cell carcinoma who had surgery. INTERVENTIONS: Intravenous opioids (remifentanil, fentanyl, sufentanil, and hydromorphone). MEASUREMENTS: Univariate and multicovariate Cox proportional hazards models were applied to assess the effects of covariates of interest on OS and RFS. MAIN RESULTS: A total of 195 patients were included. All received opioids intraoperatively. The multivariate analysis demonstrated that age (hazard ratio [HR], 1.03; P = .005), negative margin status (HR, 0.163; P = .001], postoperative chemotherapy (HR, 7.38; P < .001), and concurrent chemotherapy and radiation (HR, 3.11; P < .001) treatment and fentanyl equivalent use (HR, 1.001; P = .02) were all predictor factors for 3- and 5-year RFS. The same variables were predictor factors for OS (age: HR, 1.03 [P = .003]; negative margin status: HR, 0.14 [P = .001]; postoperative chemotherapy: HR, 4 [P < .0001]; and fentanyl equivalent use: HR, 1.001 [P = .02]). CONCLUSIONS: Our study demonstrates a very weak association between the use of intraoperative opioids and cancer recurrence after laryngeal squamous cell carcinoma surgery.