A 68-year-old woman with laryngeal tumor was scheduled for a biopsy under the general anesthesia. As dyspnea or stridor was not present and half of the laryngeal opening could be easily seen by preoperative bronchoscopy which took one month prior to the surgery, anesthesia was induced with sedatives and muscle relaxant in stepwise patterns. However, an impending total airway obstruction developed after muscle relaxant administration and emergency tracheostomy became unwanted necessity. Since a laryngeal tumor could grow large enough to make trouble in general anesthesia in a short period of time from diagnosis to operation, preoperative anticipation of airway compromise, reevaluation just before the anesthesia, communication with all operating team workers, and prompt management were needed to avoid dread complications.
Aged ; Airway Obstruction ; Anesthesia ; Anesthesia, General ; Biopsy ; Bronchoscopy ; Dyspnea ; Emergencies ; Female ; Humans ; Hypnotics and Sedatives ; Muscles ; Respiratory Sounds ; Tracheostomy

Biliary complication occurs in 6-34% of all liver transplant patients. Although bile leaks and strictures are relatively common, other biliary complications such as T-tube leak, choledocholithiasis, and biliary cast syndrome can also be observed. The biliary cast syndrome describes the presence of casts causing obstruction with its resultant sequelae of biliary infection, hepatocyte damage secondary to bile stasis and ductal damage, all contributing to cholangiopathy. Because the exact timing of cast formation after orthotopic liver transplantation is not consistent, it is difficult to define the true incidence of biliary cast syndrome without long-term follow-up data. Proposed etiological mechanisms include acute cellular rejection, prolongation of cold ischemic time, infection, biliary drainage tubes, and biliary obstruction. The diagnosis of biliary cast syndrome is usually confirmed by endoscopic retrograde cholangiopancreatography. There have been few published articles about biliary casts in Korea. Herein, we report a case of biliary cast syndrome followed by orthotopic liver transplantation.
Adult ; Bile Duct Diseases/*complications/diagnosis/etiology ; Female ; Humans ; Jaundice, Obstructive/*etiology ; Liver Transplantation/*adverse effects ; Male ; Middle Aged ; Retrospective Studies ; Syndrome