Ruptured Sinus of Valsalva (RSOV) is a rarely encountered cardiac anomaly that can potentially lead to adverse clinical outcomes. RSOV increases the risk of morbidity during pregnancy due to the physiological changes associated with gestation, that can exacerbate the underlying cardiac pathology. We present the case of a 29-year-old female with an uncorrected RSOV who required an emergency cesarean section for abruptio placenta. The patient underwent the procedure under spinal anesthesia, with careful titration of norepinephrine infusion and close monitoring of hemodynamic parameters using an invasive intra-arterial line. Given the absence of established anesthetic protocols for parturients with RSOV undergoing cesarean delivery, a comprehensive understanding of the complex interaction between the hemodynamic effects of RSOV, pregnancy, and anesthesia is essential. This understanding enables the safe use of spinal anesthesia in urgent situations, leading to favorable patient outcomes.
Sinus of Valsalva ; Aortic Rupture ; Cesarean Section ; Anesthesia, Spinal

Klippel-Feil Syndrome (KFS) continues to pose significant challenges for anesthesiologists. Beyond the expected complexities of managing difficult airways in these patients, they often present with systemic anomalies that can elevate the risk of morbidity during surgeries conducted under anesthesia. Furthermore, laparoscopic procedures bring about additional physiologic changes that must be taken into consideration when planning the anesthetic care for these individuals. This report details the anesthetic management of a 29-year-old female diagnosed with Klippel-Feil Syndrome (KFS) and concomitant Müllerian duct aplasia-Renal agenesis-Cervicothoracic Somite dysplasia (MURCS) as well as Chiari Type 1 Malformation, who underwent a successful pelvic laparoscopic surgery. The airway was secured through awake fiberoptic-guided intubation while general anesthesia was maintained with a combination of sevoflurane inhalation and remifentanil infusion. Intraoperatively, the team prioritized neuroprotection, lung-protective ventilation strategies, and renal preservation measures. The anesthetic management of patients with KFS necessitates a comprehensive assessment of their anomalies. Incorporating these considerations into the anesthetic management will help mitigate the procedure's adverse effects and lead to favorable patient outcomes.
Anesthesia ; Airway Management ; Klippel-Feil Syndrome ; Laparoscopy

Fiberoptic-guided intubation (FOI) has been an indispensable component of difficult airway management especially in instances where anatomical limitations precluded use of conventional direct laryngoscopy. Its use, however, is not without risks.

This paper presents a 4-year-old female with a limited mouth opening scheduled for an elective oral commissurotomy who developed signs and symptoms of tension pneumothorax immediately following a successful fiberoptic nasotracheal intubation. Passive insufflation of high-flow oxygen through a flexible fiberoptic bronchoscope preloaded with a tight-fitting endotracheal tube led to accumulation of air. This caused lung hyperinflation and subsequently, pneumothorax.

Anesthesia ; Airway Management ; Intubation ; Pneumothorax ; complications