Over the past 5 years, the designer drug classification of illicit substances has gained the attention of law enforcement agencies, healthcare providers, and concerned parents around the world. These drugs are often marketed as safe and legal alternatives to their already banned counterparts and are easily acquired online, at "head" shops or behind the counter at local convenient stores. This new drug class includes synthetic cathinones, synthetic cannabinoids, and phenylethylamine derivatives of the 2C class of hallucinogens. Many of these drugs were created for animal research purposes only and were never intended for human consumption. As such, little is known about their pharmacokinetic, pharmacodynamics, and adverse effect profile. Variability in preparation may further alter the already unpredictable safety profile. We report an otherwise healthy 16-year-old adolescent who presented to the emergency department for worsening left-sided weakness, new onset seizure activity, changes in mental status, and an overall decline in health. He self-reported the recreational ingestion of 25I-NBOMe prior to admission. Magnetic resonance imaging and a brain biopsy performed during the course of his admission confirmed the diagnosis of toxic leukoencephalopathy secondary to synthetic hallucinogenic drug use. The basic pharmacology and end-organ effects of 25I-NBOMe are reviewed, their adverse effect profile is presented, and potential anesthetic implications are postulated.

Wolf-Hirschhorn (WH) syndrome is a rare chromosomal abnormality with deletion of the short arm of chromosome 4. Associated clinical signs and symptoms of the condition include intrauterine growth restriction, severe psychomotor retardation, failure to thrive, characteristic facial features, profound developmental delays, seizures, and various congenital midline fusion anomalies. Given the associated congenital anomalies, anesthetic care may be required for various surgical interventions. We report a 3-month-old girl with WH syndrome scheduled for gastrostomy tube placement. Previous reports of anesthetic care for such patients are reviewed and potential perioperative concerns are discussed.

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