Epidural neuraxial analgesia is a standard procedure for pain control during labor and delivery. One rare complication is accidental epidural catheter placement in the subdural space, a potential space between the arachnoid and dura membranes.The incidence of the subdural blockade during neuraxial block is unknown. The subdural block suspicion arises when the clinical signs and symptoms do not fit epidural or subarachnoid local anesthetic injection. The clinical picture includes delayed or gradual onset, extensive sensory block with minimal motor block, hypotension more than an epidural neuraxial block, and less than spinal neuraxial block, and it can rarely track intracranially and causes dyspnea and loss of consciousness.In this article, we report a case of inadvertent subdural catheter placement that was diagnosed clinically with unexpectedly high block involving the upper extremities. No radiological confirmation was used for the diagnosis.

Patient: Female, 64-year-old Final Diagnosis: Subcutaneous emphysema following open tracheostomy during tracheostomy mask ventilation Symptoms: Shortness of breath • wheeze Medication: — Clinical Procedure: — Specialty: Anesthesiology • Critical Care Medicine Objective: Unusual clinical course Background: Tracheostomy is a surgical procedure that is done by creating an ostomy in the anterior wall of the trachea to facilitate airway access and ventilation. It is indicated for acute respiratory failure after prolonged intubation, upper airway obstruction, difficult airway, and extensive secretions. Early perioperative complications include bleeding, pneumothorax/pneumomediastinum from a false tract, sub-cutaneous emphysema, esophageal perforation, and tracheal ring fractures. Case Report: We present the case of a 64-year-old woman with a past medical history of hypertension, asthma, alcohol and cocaine abuse, bipolar, and, right breast cancer that was treated by chemotherapy and total mastectomy. She was diagnosed with adductor spasmodic dysphonia of unknown etiology 6 months ago and has been treated with Botulinum toxin injection, with an incomplete resolution. She was admitted to the Respiratory Intensive Care Unit with acute hypoxic respiratory failure associated with stridor secondary to laryngospasm, which was unresponsive to steroids and racemic epinephrine. She underwent an emergent open tracheostomy with a regular nonfenestrated tracheostomy tube. A few hours after surgery, she was weaned from mechanical ventilation to a tracheostomy mask oxygen and had an episode of strong cough followed by extensive neck and facial subcutaneous emphysema. Conclusions: Subcutaneous emphysema is a rare complication but it can be catastrophic, especially if it is associated with pneumothorax and/or pneumomediastinum. Avoiding tight a tracheostomy tube strap and fenestrated tracheostomy tube is one of the measures that can be used to avoid this complication.

Central venous catheters are routinely placed on medically complex patients for a variety of reasons, including facilitating intravenous access in difficult intravenous (IV) access situations, accurate hemodynamic monitoring, large-volume resuscitation, medication administration, nutritional support, and continuous renal replacement. As with other invasive medical procedures, placement, maintenance, and discontinuation of central venous catheters introduces risk and potential complications. We report a case of bilateral cerebral infarct secondary to air embolism through the right internal jugular vein venous catheter in the absence of intracardiac shunt in a patient with ischemic colitis who underwent total abdominal colectomy.

Calciphylaxis is a rare disease and carries high morbidity and mortality rates. It's characterized by microvascular calcification and occlusion, which leads to a life-threatening disease characterized by skin necrosis and ulceration. Calciphylaxis is classified as uremic, which occurs in patients with end-stage renal disease and who are non-uremic. Non-uremic calciphylaxis is an even rarer disease that occurs in patients without end-stage renal disease and has a high mortality rate secondary to sepsis. The most common risk factors are diabetes mellitus, hyperparathyroidism, malignant neoplasm, warfarin-based anticoagulation, alcoholic liver disease, and autoimmune disorders. The management includes wound debridement, pain management, and sepsis control.We report a case of penile calciphylaxis in a 36-year-old male with a 15-year history of type II diabetes mellitus and chronic kidney disease. He presented with penile ulceration, which rapidly progressed to necrosis. He also had skin necrosis, characteristic of penile calciphylaxis. The patient has perished of multiorgan failure secondary to severe septic shock.

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