A Commendable and Sensible but Not Novel Approach No abstract available

OxyTain: Not Unique, But a Successful Adaptation of the Royal Perth Hospital "Cannot Intubate, Cannot Oxygenate" Rescue Approach in a North American Setting No abstract available

Sphenopalatine Ganglion Blocks in the Management of Head and Neck Cancer–Related Pain: A Case Series Head and neck cancer can be painful, debilitating, and refractory to oral medications. Due to the association of the sphenopalatine ganglion (SPG) with maxillary nerve sensory fibers, SPG blocks may be used to treat the pain of the hard and soft palate, tonsils, nasal cavity, paranasal sinuses, oral gingiva, premaxillary soft tissue, maxilla, and orbital floor. We present the first case series of performing SPG blocks utilizing TX360 nasal atomizers or angiocatheters to treat head and neck cancer–related pain. Pain scores were reduced by 38% to 80% with an average pain relief duration of 23 days. Accepted for publication September 3, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Lynn R. Kohan, MD, Pain Management Center, Fontaine Research Park, Third Floor, 545 Ray C. Hunt Dr, Charlottesville, VA 22908. Address e-mail to lrk9g@hscmail.mcc.virginia.edu. © 2019 International Anesthesia Research Society

OxyTain Cannot Intubate, Cannot Oxygenate Algorithm No abstract available

Syndrome of Inappropriate Antidiuretic Hormone Release During Ketamine Infusion in Complex Regional Syndrome Patient Receiving Intrathecal Baclofen: A Case Report Complex regional pain syndrome (CRPS) is a severely disabling condition that typically develops after an inciting traumatic event. Ketamine infusion in subanesthetic dose provides sustained analgesia in selected cases of CRPS. In general, ketamine treatment does not significantly affect electrolyte or water balance. Here, we report a case of a CRPS patient on intrathecal baclofen pump developing syndrome of inappropriate antidiuretic hormone release (SIADH) during ketamine infusion. Prophylactic treatment with intravenous loop diuretics was successful in preventing the development of SIADH during ketamine infusion during subsequent infusions in this case. Accepted for publication August 14, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Michael Sherman, MD, 219 N Broad St, Philadelphia, PA 19107. Address e-mail to ms58@drexel.edu. © 2019 International Anesthesia Research Society

An Anesthesia Attempt to Be Green: How Do You Waste Your Carbon Dioxide Absorbers? Operating room waste is categorized as noncontaminated solid waste (SW) and regulated medical waste (RMW). RMW is treated by autoclaving at an increased economic and environmental cost. We evaluated these costs with a focus on the disposable carbon dioxide (CO2) absorbers. At our institution, exhausted CO2 absorbers were discarded as RMW. We collaborated with product representatives, anesthesia and perioperative staff, and waste management personnel to identify opportunities and barriers for recycling and waste reduction. Ultimately, we agreed to discard CO2 absorbers as SW instead of RMW, a strategy that is practical, less expensive, and more environmentally appropriate. Accepted for publication September 9, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Mark A. Burbridge, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine 300 Pasteur Dr, Palo Alto, CA 94304. Address e-mail to markburb@stanford.edu. © 2019 International Anesthesia Research Society

Ultrasound-Guided Intermediate Cervical Plexus Block With Depot Steroids in the Management of Refractory Neck Pain Secondary to Cervicothoracic Myofascial Pain Syndrome: A Case Series Persistent cervicothoracic myofascial pain is a common condition that causes loss of function and can result in significant health care costs. The underlying cause is tender trigger points that result in impaired muscle function. Standard treatment includes physiotherapy, medications, acupuncture, and trigger point injections. Patients who fail to respond have very limited treatment options. The authors present a novel treatment in 2 patients presenting with severe unilateral cervicothoracic myofascial neck pain that failed to respond to standard treatment. The novel treatment, ultrasound-guided intermediate cervical plexus block with depot steroids, produced significant and durable pain relief in the 2 patients. Accepted for publication August 22, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Gopinath Niraj, FFPMRCA, Department of Pain Medicine, University Hospitals of Leicester NHS Trust, Gwendolen Rd, LE5 4PW, United Kingdom. Address e-mail to niraj.g@nihr.ac.uk. © 2019 International Anesthesia Research Society

Transnasal Humidified Rapid-Insufflation Ventilatory Exchange for Elective Laryngeal Surgery During Pregnancy: A Case Report Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) maintains oxygenation and blunts the partial pressure of carbon dioxide (PaCO2) rise in nonpregnant subjects during apnea. Physiologic changes of pregnancy may attenuate the utility of THRIVE. We present a nulliparous patient at 31 weeks’ gestation undergoing tracheal dilation requiring general anesthesia without intubation utilizing THRIVE. Our data confirms prior reports in nonpregnant patients showing markedly extended time to desaturation. However, PaCO2 rise more closely mirrors classic apneic oxygenation in nonobstetric patients. The PaCO2 elevation and subsequent acidosis may limit the utility of THRIVE for prolonged apnea in pregnant surgical patients. Accepted for publication August 20, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Brendan Carvalho, MBBCh, FRCA, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305. Address e-mail to bcarvalho@stanford.edu. © 2019 International Anesthesia Research Society

Gastric Ultrasound Imaging to Direct Perioperative Care in Pediatric Patients: A Case Report of 2 Cases Pulmonary aspiration of gastric contents carries significant risk in children in the perioperative period. Ultrasound imaging of the gastric antrum has been validated to predict gastric content and volume in both pediatric and adult patients, and yet clinical applications in pediatric patients are sparse. We report 2 cases of children presenting for elective surgery with uncertain volume of gastric contents. Bedside gastric imaging successfully identified “full stomachs,” and the information was used to direct care. Accepted for publication August 21, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Karen R. Boretsky, MD, 300 Longwood Ave, Boston, MA 02115. Address e-mail to karen.boretsky@childrens.harvard.edu. © 2019 International Anesthesia Research Society