Ankylosing Spondylitis (AS) may present significant issues to the anaesthesiologist as potential difficult airway, respiratory and cardiovascular complications, and the concomitant medication therapy to modify symptoms and disease. Awake fibreoptic intubation (AFOI) is a safe option in anticipated difficult airway, as it permits neurological monitoring throughout the attempt at achieving definitive airway. Central neuraxial blockade and peripheral nerve blocks may have good application for these cases. This morbidity renders the patients to greater risk of neurological complications in the peri-surgical period. Neurophysiological monitoring assists the clinician in timely diagnosis and intervention during surgery for cervical spine deformity correction. Addition of anti-tumour necrosis factor-α agents to the medical management has resulted in improved outcomes, however, with concomitant increased potential for wound infections in treated patients. Understanding of potential issues can pave the way for appropriate perioperative management.
Tracheal resection and primary anastomosis is the treatment of choice for a short-segment stenosis. However, the procedure does carry the risk of two potentially fatal complications: Anastomotic breakdown and anastomotic leak. We describe a case of 24-year-old man who was treated for a 4 to 5 cm tracheal stenosis secondary to a prolonged intubation and tracheostomy after organophosphorus poisioning. The patient underwent a tracheal resection and primary anastomosis under general anaesthesia with the use of 7.5 mm tracheotracheal tube. The patient was extubated postoperatively after 2 days of controlled ventilation. After 25 days, patient came with tachypnoea, stridor and respiratory distress in emergency department, which was dealt by tracheal dilatation and tracheal stenting. Patient was discharged the next day, with the advice of stent removal after 6 weeks. Even after 1 year, patient did not attend the follow-up clinic, but he communicated to us stating that he has no problem.
Central venous access is an increasingly frequent procedure and intravenous catheter fractures and fragments embolisation, although being rare, corresponds to common intravascular foreign bodies with potential catastrophes especially in patients with congenital heart defects. A case report is presented with a fracture migration of venous catheter, its endovascular retrieval and suggestions to reduce the incidence of this complication.
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