Introduction. Saber-sheath trachea is a rare malformation of the trachea marked with coronal narrowing with concomitant widening of sagittal diameter, with a sagittal-to-coronal diameter ratio exceeding 2:1. As tracheal rings are stiff and do not collapse around the tube, the intubation is difficult. Case Report. A 53-year-old female was referred to our hospital due to failed intubation at the local hospital during a planned surgery of skin melanoma. The patient was scheduled for surgery in our hospital, her case was presented to a panel of anesthesiologists and she was prepared for surgery. The intubation failed again, even though a video-assisted laryngoscope and endotracheal tube with 5 mm internal diameter was used. The anesthesiologist noticed that the endotracheal tube entered the trachea only 2 cm due to strong resistance, so further intubation was not an option in order to avoid damaging the trachea. The surgery was performed in local anesthesia with analgosedation. Later on, computed tomography was done, because of suspected pathological process compressing trachea, but the radiologist described the anomaly as saber-sheath trachea. One year later, the patient presented with axillary lymph node metastases and needed another surgery. This time the anesthesiologist knew about the trachea malformation, anticipated difficult intubation and used i-gel TM for airway management. Conclusion. Despite the fact that numerous methods have been developed for the purpose of identifying patients at risk of difficult intubation, there are many unexpected airway pathologies that can lead to failed intubation. Adequate preoperative assessment, knowledge of Guidelines for Difficult Intubation Management, availability of supraglottic airway devices, and cooperation between the surgeon and anesthesiologist, are crucial to successful patient management.

Hospital environments provide a special setting for the interaction of microbiological agents of infection and a host of patients and healthcare workers. Although the basic tenets about the spread of infections in hospital have not changed, new issues have emerged that make infection control more problematic. The aim of this paper was to provide the epidemiological characteristics of nosocomial infections and pathogens among patients in an intensive care unit (ICU), the department with the highest risk of the infections associated with medical devices and healthcare

For patients with pancreatic cancer, surgical resection still remains the only chance of cure. These procedures are performed with acceptable postoperative mortality and morbidity rate. The percentage of cured patients is still unsatisfactorily low.

A propofol/remiWentanil combination provided safe and effective analgosedation of the patient.

AbstractCentral venous cannulation is a widely used procedure in clinical medicine. Central venous catheters are inserted most often via the internal jugular and subclavian veins. One of the complications is malpositioning of the catheter, and some insertion sites carry a higher risk for that occurrence. We report a case of a malpositioned central venous catheter inserted via the left internal jugular vein in a patient with a ruptured diaphragm. Our objectives were to review the venous anatomy of the chest and the literature reporting malpositioned central venous catheters and to discuss the approach through the left internal jugular vein. Left internal jugular cannulation could carry a higher rate of malposition than reported, and anatomy gives a possible, simple answer. Contrast enhancement, although central venous catheters are radiopaque, is helpful when an approach through the left internal jugular vein is used and difficulties are encountered during insertion.