Pheochromocytoma is a rare catecholamine-producing tumor that can cause severe hypertension and other systemic disturbances. A clinical challenge arises when a patient with a previously undiagnosed and untreated pheochromocytoma presents with a surgical emergency. We describe a patient presenting with acute appendicitis in whom surgery was cancelled because of suspected pheochromocytoma. The possibility of mortality associated with surgery in a patient with an undiagnosed pheochromocytoma outweighed the risk of nonoperative management for appendicitis. This case resulted in a nonoperative resolution of appendicitis and an unremarkable recovery once appropriate hypertension treatment was administered.

These findings describe a mechanism for false-negative results from decreased posterior tracheal wall tone during cardiac arrest. Further studies are required to elucidate factors contributing to its occurrence and impact on EDD use.

This study identified 100 ambulatory surgery patients receiving general anesthesia who were at increased risk for postoperative nausea and vomiting (PONV) and randomly assigned them to receive single-agent prophylaxis (12.5 mg of dolasetron or 4 mg of ondansetron) 15 to 30 minutes before the end of surgery. Data were collected in the postanesthesia care unit, and patients completed a questionnaire 24 hours after surgery. No statistically significant difference existed between study groups in demographic features, history of PONV, history of motion sickness, or type and duration of surgery and anesthesia. No statistically significant difference existed in satisfaction with the medication used for PONV prophylaxis (dolasetron, 70.9 of 100 mm; ondansetron, 67.9 of 100 mm; p = 0.69). No statistically significant difference existed in satisfaction with the overall surgical experience (dolasetron, 87.9 of 100 mm; ondansetron, 85.3 of 100 mm; p = 0.36). Costminimization strategies should be considered without fear of substandard care or increased patient dissatisfaction.

The difficult intubation is one of the most trying situations encountered in airway management. Transtracheal jet ventilation via needle cricothyroidotomy can provide temporary oxygenation in this critical situation in a minimally invasive fashion. The esophageal detector device (EDD) has been previously shown to be effective in determining the tracheal placement of endotracheal tubes. In this experiment, three commonly available EDDs are utilized to accurately identify 15 of 15 intratracheal placements of a 16-gauge i.v. catheter in five cadaveric domestic swine. The incorporation of EDDs in i.v. catheter placement for needle cricothyroidotomy is shown to be effective and merits further study. Likewise, further investigation is needed to identify a standardized apparatus for needle cricothyroidotomy in emergent situations.