We describe a case of a very difficult intubation which was safely navigated through careful planning. Our patient presented initially with increasing hoarseness and shortness of breath over a 6-month period. This was investigated and the patient was found to have a large vocal cord mass and was referred for urgent microlaryngoscopy and vocal cord polypectomy. On the day of surgery the obstruction was noted and awake fiberoptic bronchoscopy was used with a remifentanil infusion. Given the mass was large and increased in size with expiration, the time frame to pass the tube was extremely short. We delivered a transtracheal injection of local anaesthesia. This approach allowed for safe passage of the endotracheal tube. In patients such as this it may be worth considering the use of a transtracheal injection in the first instance.

We report a case of pseudohypertrophy of the left ventricle secondary to hypovolaemia from anaphylaxis. The patient was a healthy young female who developed anaphylaxis during a general anaesthetic. A transthoracic echocardiogram performed during the anaphylaxis crisis demonstrated significant left ventricular hypertrophy. However, when the anaphylaxis had resolved, a follow-up transthoracic echocardiogram demonstrated a normal left ventricular wall thickness. This left ventricular hypertrophy was a pseudohypertrophy as the left ventricular mass was normal and the wall thickness normalised when the hypovolaemia and anaphylaxis had resolved. Pseudohypertrophy of the left ventricle is an echocardiographic finding that suggests hypovolaemia. Furthermore, this echocardiographic finding supports the importance of volume resuscitation in the management of anaphylaxis. This phenomenon may be more frequently reported in the future due to the wider availability of point-of-care ultrasonography along with an increase in the number of physicians trained in echocardiography.

Pyrexia is an elevation of body temperature above the normal range due to an increase in the hypothalamic thermoregulatory set point. Hyperpyrexia is an extreme elevation of body temperature equal to or greater than 41.5°C (106.7°F). (1) Malignant hyperpyrexia is a rare and idiopathic extreme elevation of core body temperature above 42°C characterized by the acute onset of hyperthermia, coagulopathy and shock. (2) It is potentially life-threatening and can rapidly progress to severe liver and renal impairment, acidosis and encephalopathy. Reported here is a case of malignant hyperpyrexia in a patient with injury of the cervical spine.