Anesthetic management of superior vena cava syndrome carries a possible risk of life-threatening complications such as cardiovascular collapse and complete airway obstruction during anesthesia. Superior vena cava syndrome results from the enlargement of a mediastinal mass and consequent compression of mediastinal structures resulting in impaired blood flow from superior vena cava to the right atrium and venous congestion of face and upper extremity. We report the successful anesthetic management of a 42-year-old man with superior vena cava syndrome posted for cervical lymph node biopsy.

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An 8-year study of urinary fistulae from 1974 to 1981 was done in the University Teaching Hospital, Lusaka, Zambia. The analysis revealed no significant decrease in the number of urinary fistulae referred to the Department of Obstetrics and Gynaecology of the University during the period. Of 61 cases reviewed, 54 were consequent to obstetrical trauma of prolonged labor and superimposed operation or instrumentation. Four fistulae occurred as a complication of gynecologic surgery, while three originated from advanced malignancy of the cervix. Operative management of fistulae is discussed. Further reorganization of rural maternity services in Zambia is suggested as a preventive measure.

A 74-year-old female with diabetes mellitus type II and Alzheimer's disease, taking donepezil for 4 months was operated for right modified radical mastectomy under general anesthesia. During the procedure a higher dose of non-depolarizing muscle relaxant was required than those recommended for her age yet the muscle relaxation was inadequate intra-operatively. Residual neuromuscular blockade persisted postoperatively, due to the cumulative effect of large doses of non-depolarizing muscle relaxant, needing post-operative ventilatory assistance. After ruling out other causes of resistance to non-depolarizing muscle relaxants, we concluded that acetylcholinesterase inhibitor donepezil was primarily responsible for inadequate muscle relaxation and delayed post-operative neuromuscular recovery.

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