Ventriculo peritoneal (VP) shunt uncommonly complicates as intracranial hematomas which can still occur in patients with a functioning VP shunt leading to a delay in the diagnosis which can be extremely dangerous and lead to adverse outcomes. We report a case of an incidental diagnosis of delayed post-operative EDH following VP shunt in an young adult patient with a right cerebellar lesion and highlight the need for meticulous post-operative neurological examination.
Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP) therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery.
W E report an interesting aspect of a difficult intubation in a 10-yr-old boy scheduled for excision of a retropharyngeal mass. As can be appreciated from the magnetic resonance imaging, there is a large retropharyngeal tumor shown in figure A, and the axial cut (fig. B) shows the tumor causing a significant anterior and lateral shift of trachea of approximately 20 mm. After induction of general anesthesia and testing that mask ventilation would be possible, an endotracheal tube with an ID of 7 mm was inserted using direct laryngoscopy. It was inserted up to 17 cm at the incisors as per the calculation 12 + age (yr)/2. 1 The patient was positioned with a slight extension of the neck, which may have caused the dislocation of the tube, which was quickly diagnosed by the sudden disappearance of the end-tidal carbon dioxide waveform. The patient was reintubated using another endotracheal tube and advanced 2 cm more to 19 cm, which resolved the issue. This case is being reported to highlight the possibility of applying "calculations" to decide the length of the endotracheal tube to be inserted for correct tube placement. In this case, a further allowance of 2-3 cm should have been made, considering the extra 20-mm length that the tube had to traverse due to the curvature of the tumor, as shown in figure A. We would also like to highlight the fact that in patients with significant tracheal deviation, the tube position should be confirmed with fibreoptic bronchoscopy, fluoroscopy or x-ray films. 2,3
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.