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Airway management in patients with head and neck contractures can be very challenging. Severe facial and neck scars may predict difficult mask ventilation. Difficult intubation should also be expected. We analyzed the airway management in an adolescent with severe post burn head and neck contractures. The challenges during airway approach are discussed and a comprehensive analysis regarding the option for fiberoptic intubation using an I-gel laryngeal mask as a conduit is also performed. Considering the scarce literature in this topic, the techniques described here represent an important contribute to the process of decision-making when planning the airway approach in these patients.

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Sugammadex has proven to be highly effective for the reversal of moderate or deep neuro¬muscular blockade induced by rocuronium or vecuronium. We present a case where optimal conditions for tracheal intubation were attained using rocuronium (0.5 mg kg -1 ) 20 minutes (min) after sugammadex had been given. A 59-yr-old female patient, ASA II was scheduled for elective total thyroidectomy. Anesthesia included propofol, fentanyl and rocuronium with sugammadex for neuromuscular blockade reversal, and sevoflurane/air for maintenance. 20 minutes after reversal of neuromuscular blockade with sugammadex the patient returned to operating room for evacuation of cervical hematoma and second general anesthesia was induced with the usage of rocuronium (0.5 mg kg -1 ) and propofol 2 mg kg -1 . Good intubation conditions were obtained after approximately 2 minutes and tracheal intubation was performed uneventfully without any observed desaturation below 96%. Patient returned to post anesthesia care unit after the second procedure, well and fully recovered, and had hospital discharge after 3 days.Our case shows that a short time of twenty minutes between use of sugammadex and rocuronium (0.5 mg kg -1 ) did not affect intubation conditions, with normal induction doses of propofol.

The management of pregnant patients with aneurysms represents a challenge. Vertebral aneurysms are an exceedingly rare condition. Their management is not defined due to the scarcity of cases. The best technique to reduce aneurysm rupture risk with simultaneous maternal and fetal wellbeing preservation is not established. The authors present a case of 41-year old pregnant woman, proposed for an elective cesarean section because of a previously described vertebral aneurysm waiting for repair after delivery. The concerns related to anesthetic management, including the advantages and disadvantages of general and neuraxial anesthesia in this specific case are discussed.

Peribulbar block was a safe anesthetic technique in our sample considered.