Surgical resection of obstructive tracheal tumors can be challenging to cardiothoracic surgeons and anesthesiologists. It is often difficult in these cases to maintain oxygenation by face mask ventilation during induction of general anesthesia. Also, the extent and location of these tracheal tumors can preclude conventional induction of general anesthesia and subsequent successful endotracheal intubation. Peripheral cardiopulmonary bypass (CPB) under local anesthesia and mild intravenous sedation may be safe to support the patient until securing a definitive airway. We describe a case of a 19-year-old female with a tracheal schwannoma, who developed differential hypoxemia (Harlequin, or North-South, syndrome) after institution of awake peripheral femorofemoral venoarterial (VA) partial CBP. K E Y W O R D S differential hypoxemia, femorofemoral cardiopulmonary bypass (CPB), harlequin syndrome, north-south syndrome, venoarterial (VA) extracorporeal membrane oxygenation (ECMO), venovenous (VV) extracorporeal membrane oxygenation (ECMO) How to cite this article: Karam C, Nafeh NA, Aouad MT, et al. Harlequin syndrome during peripheral cardiopulmonary bypass in a patient with an obstructing tracheal schwannoma: A case report.

Surgical resection of obstructive tracheal tumors can be challenging to cardiothoracic surgeons and anesthesiologists. It is often difficult in these cases to maintain oxygenation by face mask ventilation during induction of general anaesthesia. Also, the extent and location of these tracheal tumors can preclude conventional induction of general anesthesia and subsequent successful endotracheal intubation. Peripheral cardiopulmonary bypass (CPB) under local anaesthesia and mild intravenous sedation may be safe to support the patient until securing a definitive airway. We describe a case of a 19-year-old female with a tracheal schwannoma, who developed differential hypoxemia (Harlequin, or North-South, syndrome) after institution of awake peripheral femorofemoral venoarterial (VA) partial CBP.

In a multidisciplinary approach between the anesthesiologist and the ophthalmologist, we report the successful use of high-flow nasal canula (HFNC) oxygen therapy in a sedated, obese, anxious, old patient undergoing cataract surgery under deep intravenous (IV) sedation to eliminate his upper airway obstruction, heavy snoring, apnea, and oxygen desaturation while using a regular nasal cannula for oxygen supply, thus avoiding the need for general anesthesia with endotracheal intubation or case cancelation.

We present a case of suspected bullous pemphigoid lesions after spinal anesthesia in a previously healthy parturient presenting at term for an elective secondary cesarean section. On day 1 post-partum, pruritic red fluid-filled clustered bullae highly resembling those of bullous pemphigoid were noted around the spinal anesthesia injection site. Fusidic acid/betamethasone skin cream was prescribed by a dermatologist for twice-daily application. The bullae decreased in size gradually and became crusted 1 week post-partum with mild residual pruritus. At 6 weeks post-partum, the bullae completely disappeared without a scar. Checking the site of neuraxial blockade on the first day postoperatively allowed early detection of such unique skin lesions.

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