Purpose The purpose of this study was to determine which types of facial injuries in traumatic patients' wounds cause difficult intubation for anesthesiology team. By anticipating potential complications with airway management, the surgeons can be better prepared for emergent cricothyrotomy if needed. This could include prior to the planned procedure in the operating room (OR) as well as in emergent conditions in trauma bay. Methods Trauma patients with facial injuries in a level II trauma center from January 2007 to September 2017 that required intubation were evaluated for types of facial injury. Anesthesiology intubation documents were reviewed to determine which types of facial injuries were associated with difficult intubation per anesthesiology documentation. Results A total of 232 subjects were selected and it was found that patients with LeFort II facial fracture, bilateral mandibular fracture, and facial fracture associated with basilar skull fracture were noted to have difficult intubation by the anesthesiology team. Conclusion On the basis of CT imaging findings, our study demonstrates that certain types of facial fractures could pose difficult intubation. Surgeons should be aware of these injuries and be ready to intervene with emergent cricothyrotomy if necessary.

Herpes simplex virus is an infection that can result in a variety of symptoms ranging from blistering or ulcers to severe, systemic manifestations. We report a case of patient who underwent elective spinal surgery and developed invasive herpes as well as candidiasis postoperatively without any direct evidence of immunosuppression.

Background: Total intravenous anaesthesia is a technique in which induction and maintenance of anaesthesia is achieved with intravenous drug alone. With analgesics complete anaesthesia can be achieved. Objectives: To study & compare the hemodynamic profile, intra operative analgesic adequacy, VAS score and emergence time between two groups. Subjects and Methods: Total 80 patients of ASA grade I & II, aged 18-60years old, who were posted for short surgical procedures were randomly divided into two groups. Group I received Inj.Butorphanol 20μg/kg and Group II received Inj.Fentanyl 2μg/kg body weight. Both the groups received Inj. Propofol 2mg/kg I.V. and then maintenance of anaesthesia started with Propofol as a stepped down scheme. Intra operative depth of anaesthesia was monitored using clinical signs like rise in blood pressure, pulse and respiratory rate. Post-operative sedation score was noted using Ramsay Sedation score. Visual analogue score for pain, was noted at the time of emergence time. Results: Respiratory rate, heart rate and SpO2 showed no significant differences between groups. Average systolic and diastolic BP in group I was lower as compared to group II during the surgery and post-operative at the time of emergence also. Mean emergence time in group I was significantly higher than group II. Mean VAS at the time of emergence was significant less in butorphanol group. Conclusion: From the present study it can be concluded that, Butorphanol & Fentanyl combined with Propofol are comparable in hemodynamic profile. Post-operative more time is taken for emergence in Butorphanol group. VAS score for pain at the time of emergence is more in Fentanyl group compared to Butorphanol. With conventional monitoring, depth of anaesthesia is satisfactory between groups. With both the drugs satisfactory anaesthesia can be provided for short surgical procedures which are 30 or less in duration.

Goblet cell carcinoid (GCC) tumor is a rare appendiceal carcinoma that has had several names throughout its history. Often found incidentally on pathology following an appendectomy, treatment includes a right hemicolectomy and possible adjuvant chemotherapy. Survival rate has been shown to be correlated with the histological features. Here, we report a 45-year-old African American male who presented with signs and symptoms consistent with acute appendicitis, but was ultimately diagnosed with GCC. After undergoing a right hemicolectomy, he continues to undergo long-term surveillance with his oncologist. Due to the rarity of this tumor, we describe the history of GCC and our recommendations for surgical and long-term management.