Hypotension during kidney transplantation can be common. Vasopressor use during these procedures is often avoided, with a fear of decreasing renal perfusion in the transplanted kidney. However, adequate perfusion for the rest of the body is also necessary, and given that these patients often have underlying hypertension or other comorbid conditions, an appropriate mean arterial pressure (MAP) has to be maintained. Intramuscular injections of ephedrine have been studied in the anesthesiology literature in a variety of case types, and it is seen as a safe and effective method to boost MAP. We present a case series of three patients who underwent renal transplantation and who received an intramuscular injection of ephedrine for hypotension control. The medication worked well for increasing blood pressures without apparent side effects. All three patients were followed for more than one year, and all patients had good graft function at the end of that time period. This series shows that while further research is necessary in this arena, intramuscular ephedrine may have a place in the management of persistent hypotension in the operating room during kidney transplantation.

Radiation therapy allows patients to receive focused radiation to a tumor. Some patients require anesthesia for their daily treatments. For head and neck tumors, a thermoplastic mask is created to minimize movement. We describe a case where a patient’s neck circumference increased during the course of treatment. Given that the patient was under anesthesia for each treatment, he was not able to relay the tightness of the mask. This led to cerebral hypoxia. Cerebral oximetry confirmed this diagnosis, and the patient’s mask was refitted—remaining anesthetics were uneventful. Mask fitness should be reassessed during the treatment series.

Awake nasotracheal fiberoptic intubations are used to manage difficult airways. Nasopharyngeal airways can be placed into the nostril to facilitate fiberoptic intubation and has been shown to be a useful pathfinder. We describe a case where this nasopharyngeal airway was inadvertently advanced with the bronchoscope and led to partial tracheal obstruction. To our knowledge, this represents the first reported case of this mishap. Aspiration of the nasopharyngeal airway can lead to complete airway obstruction and devastating consequences. Simple techniques such as attaching a hemostat or using an assistant to hold on to the nasopharyngeal airway may prevent this occurrence.