A patient undergoing laparoscopic radical prostatectomy developed unilateral periorbital edema and cervical subcutaneous emphysema following carbon dioxide insufflation into the retropubic and retroperitoneal space. He had hypercarbia and acidosis during and after the end of the case and he required hyperventilation in the recovery room for two hours before the hypercarbia subsided and the arterial blood gases returned to normal levels. Despite massive surgical emphysema reaching up to his face, there was no evidence of a pneumothorax or pneumomediastinum in this patient. He had no respiratory distress and his visual examination was normal and the periorbital surgical emphysema subsided gradually within two days. The management of this complication and a review of the literature is presented.

Chondrosarcomas of the larynx are rare tumors, representing less than 0.2% of all head and neck malignancies [1]. In this report, we present an unusual case of an undiagnosed chrondrosarcoma of the larynx presenting as difficult intubation in an otherwise asymptomatic patient. Difficult intubation in an otherwise asymptomatic patient has not been reported as an initial presentation of this tumor. Men are more commonly affected than women (3.6: 1), and the tumors typically present in the fifth or sixth decade of life. Patients may present with dyspnea, dysphagia, hoarseness of the voice, airway obstruction and some may have pain as a result of expansion of this tumor. The tumors almost always arise from hyaline cartilage, with the most common site of involvement the cricoid cartilage (75%), specifically the posterior lamina, with the thyroid cartilage and arytenoid cartilage less frequently involved. Though locally invasive, these tumors are characterized by a low tendency for distant metastasis and the overall prognosis following excision is excellent [2].Keywords: Difficult intubation, chondrosarcoma, larynx. CASE REPORTA 78 year old man was scheduled for a right knee replacement surgery. He had a past medical history of atrial fibrillation and hypertension and he was taking an angiotensin receptor blocker (Olmesartan), a thiazide diuretic (hydrochlorthiazide), and an anti-coagulant (Coumadin). He had no known drug allergies and had an unremarkable review of systems, including symptoms of dysphagia, odynophagia, stridor, dyspnea, or hoarseness. His medical history was likewise unremarkable with regard to smoking and alcohol intake. He was 71" tall and weighed 211 lbs (BMI = 29.4 kg/m 2 ), with a Mallampati class lll airway. The thyromental distance was four finger breadths and he had good neck extension. He had a marked class III skeletal profile and the teeth were in good repair with no dentures or implants. His vital signs and laboratory workup were unremarkable. The patient refused spinal anesthesia. As such, the case was performed under general anesthesia.The patient was premedicated with 2 mg of Midazolam and 100 mcg of Fentanyl. After adequate preoxygenation he was induced with 250 mg of propofol and 100 mg of succinylcholine. A first attempt at intubation was attempted by the nurse anesthetist using a Macintosh size 3 blade laryngoscope and was unsuccessful. During direct laryngoscopy on a the subsequent attempt by the staff anesthesiologist, using *Address correspondence to this author at the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Instructor in Anesthesia, Harvard Medical School, Boston, MA, USA; Tel: 6177247182; Fax: 6177264489; E-mail: jsarma@partners.org a Macintosh size 4 blade, the view was poor, but a small bulge under the right posterior vocal fold was visualized. The glottic aperture was deviated to the left and was narrowed ( Fig. 1). A standard bougie was passed under direct vision through the glottic aperture and a 7.0 mm cuffed...

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Bony exostoses such as mandibular tori are fairly common. They are asymptomatic, benign cortical bony protuberances occurring along the lingular aspect of the mandible. Large tori may interfere with direct laryngoscopy resulting in difficult intubation. This is a case report about a 66 year old, Caucasian male with a Mallampati class I airway who was un-intubatable initially, due to the presence of bilateral mandibular tori that formed a plate of bone beneath his tongue. He was intubated subsequently with the help of an Eschmann bougie.

SAF-R surgical board is a safe, reliable, and timesaving positioning device for patients undergoing robotic pelvic surgery in the T-burg position.