Floppy epiglottis in an adult is rare and often pathological. Airway obstruction caused by floppy epiglottis in an adult is rarely reported. Neck mass, however, can affect the airway in many ways; however, inducible upper airway obstruction by extra-laryngeal neck mass is hardly been reported. In most of the instances of inducible laryngeal obstruction, the tumor is found in and around the laryngeal inlet. Herein, we report such an unusual incident happened to a 40-year-old gentleman, a case of oral carcinoma for 3 months and a rapidly increasing swelling (6 × 5 cm) over the right side of the neck for 8 days. He presented to us for emergency tracheostomy with the feature of acute upper airway obstruction, unable to lie down; and having difficulty in breathing, desaturation, and chocking even in propped up position. The case highlights the importance of clinical findings and difficulties faced for airway management in such patients.

Use of nitrous oxide (N2O) as an anaesthetic gas has been on contradicting views for various reasons; operating room (OR) pollution and occupational exposure is one of those controversies. The present pilot experiment was planned to analyze the anaesthesia gas waste at the machine end of scavenging outlet and calculate the probable portion of N2O in the OR air, which is likely to help us in informed decision making. Anaesthesia gas waste was sampled at the machine end of scavenging outlet and was connected directly and analyzed using a gas analyzer attached to Mindray A7 anaesthesia workstation. An assembly of L connector, sampling line, corrugated tube and endotracheal tube were used to perform the procedure. The measurements were taken at 600, 1200 and 1800 mL/minutes of fresh gas flow (FGF). A total of 15 paired readings from five general anaesthesia cases were taken. The N2O percentage in the anaesthesia waste gases with a FGF of 600, 1200 and 1800 mL was 3.4 ± 0.54, 8.2 ± 0.83 and 14.0 ± 0.70, respectively. On calculation, the likely concentration of N2O in OR with FGF of 600 mL/min is 0.576 ppm, which will lead to the time weighted average 4.6 ppm exposure per day in modular OR. Reducing FGF to 600 mL/min reduces the N2O concentration in OR by 75% as compared to the FGF of 1800 mL/min. The time weighted average exposure to N2O is far below the permissible limit in modular OR.

Hyponatremia is a common electrolyte disorder, especially in the frail elderly population. With the increasing number of surgeries in the aging population, hyponatremia is frequently encountered by anesthesiologists and surgeons. Unfortunately, management of hyponatremia is often complex in the elderly population as it is often multifactorial, and they are physiologically susceptible. While it is well known that preoperative hyponatremia is associated with increased perioperative morbidity and mortality, a lack of recommendations or guidelines adds to the dilemma in managing such cases. The most common cause of chronic hyponatremia in the elderly is the syndrome of inappropriate antidiuretic hormone (SIADH), which can be resistant to conventional treatment. On the other hand, paraneoplastic SIADH leading to hyponatremia is rare, and surgery may be the only option available for its correction. We present a case of a 78- years-gentleman to highlight such a dilemma. He was diagnosed with renal cell carcinoma and had chronic refractory severe hyponatremia despite treatment with fluid restriction, low dose hydrocortisone, tolvaptan, and 3% sodium chloride.

No abstract