Six infants were referred with symptoms and clinical signs suggesting airway obstruction during sleep. In each case, overnight recordings of arterial oxygen saturation, respiratory movements and end tidal expired carbon dioxide (ETCO2) showed the presence of abnormal episodes of hypoxaemia related to partial or complete airway obstruction and associated with a specific pattern of the inspiratory movement waveforms. These events and patterns were not found on recordings from 20 age-matched healthy infants and young children. ETCO2 levels were also abnormally elevated in all six patients when asleep. Fiber-optic upper airway endoscopy excluded structural abnormalities, including significant tonsillar or adenoidal enlargement, but showed an intermittent dysfunctional inspiratory obstruction in the pharynx. Continuous positive airways pressure and tracheostomy were effective in treating this obstruction.

The beneficial role and efficacy of Tranexamic Acid in reducing perioperative blood loss and blood transfusion requirements in spine surgery is being established. Tranexamic Acid is an antifibrinolytic agent traditionally used to lessen perioperative blood loss. Tranexamic Acid can be administered orally, intramuscularly, intravenously or topically. Tranexamic Acid studies in spine surgery have limited patient enrolment. Most of the reported studies have mixed results and difficult to interpret. The efficacy of antifibrinolytic agents is evident in a wide variety of surgical procedures: liver transplantation, obstetrics and gynaecology, trauma and orthopaedic surgical procedures. The effect of Tranexamic Acid on the occurrence of thromboembolic events, strokes, myocardial ischemia, seizures and mortality has not been adequately assessed and remains uncertain. A number of possible complications reported. In this review, we analyze the efficacy and safety profile of perioperative Tranexamic Acid with the exclusion of cardiac surgery and a focus on major spinal surgery.

We report a case of an adult male with an acute retropharyngeal hematoma secondary to a closed and stable C5-C6 vertebral fracture that caused severe upper airway obstruction resulting in a 'cannot-intubate-cannot-ventilate' scenario.Awareness of this issue and hyper vigilance in suspected cervical vertebral fracture patients can enable adequate preparation for a difficult airway scenario. The need for emergency tracheostomy must be anticipated and suitable help available for the same.

Epilepsy surgery as a treatment option is usually reserved for medically intractable epilepsy, when anticonvulsant medication has failed to achieve adequate seizure control and the seizure frequency impairs quality of life. Intraoperative brain mapping is often requested by the surgeon and necessitates special planning by the anesthesiologist to provide the best possible operating conditions. Awake craniotomy with the “asleep-awake-asleep” pattern can be considered as a technique in such procedures but requires cautious management for achieving maximum patient satisfaction. Certain patients are not appropriate candidates for craniotomy in the awake state, but general anesthesia can still be considered with specific considerations.

Background: Although Retropharyngeal Hematoma (RPH) has unknown frequency but considered a rare condition which can cause a life threatening airway obstruction. Various precipitating factors have been mentioned as causes of RPH as blunt head or neck trauma, whiplash injury, coagulopathy, central line insertion, stellate ganglion block, sneezing, severe coughing as well as spontaneous RPH. Methods: We report a case of severe life threatening retropharyngeal hematoma secondary to a closed stable C5-C6 fracture that caused severe upper airway obstruction. Results: As the RPH can develop hours or days, even after an apparently minor precipitating injury, in our patient it took almost 3 hours from time of accident till the development of severe upper airway obstruction (picture to be added in main poster). It was such a large collection hematoma that caused severe upper airway obstruction with cannot intubate cannot intubate situation. Conclusion: RPH can cause a mechanical displacement of the pharynx & larynx making securing airway with ETT almost impossible with conventional laryngoscopy or even video-assisted techniques. On the other hand, the time taken for RPH to develop and to cause mechanical obstruction can be limited enough to allow proper preparations as well as availability of fiberoptic technique. We should keep a high index of suspicion of retropharyngeal hematoma and airway involvement in cases of cervical spine fracture, in order to help other physician to increase their awareness and anticipation of such life threatening & meantime avoidable condition. Keywords: retropharyngeal hematoma, airway obstruction