Surgical interventions involving the face, particularly in elderly or medically complex patients, present unique anesthetic challenges. We report the case of a 70-year-old woman with multiple comorbidities who underwent excision of a midline frontal basal cell carcinoma (2.5 cm × 2 cm) under regional anesthesia and sedation. Bilateral supraorbital, supratrochlear, and zygomaticotemporal nerve blocks were performed. Sedation was maintained with intravenous bolus fentanyl and propofol infusion. The procedure was completed without complications, with excellent analgesia and hemodynamic stability. Scalp nerve blocks may offer a safe and effective alternative to general anesthesia for forehead surgeries, particularly in high-risk patient populations.

Idiopathic multicentric osteolysis (IMO) is a rare disease characterized by rapid spontaneous bone loss, typically affecting the carpal and tarsal bones. Patients with IMO often suffer from chronic pain, immobility, and renal disease, posing challenges for pain control in the perioperative setting. We present the case of a 19-year-old woman with Gorham-Stout syndrome, a subtype of IMO, who underwent a successful femoral nerve block and catheter placement under general anesthesia for palliative knee resection. This case report illustrates the safety and efficacy of regional anesthesia for postoperative pain control, emphasizing its potential benefits in this unique patient population.

Earlier, we reviewed mathematical and psychological studies of staff scheduling for holidays. Our management case report describes innovation and applying the results. Each anesthesiologist was assigned 100 points among holidays to work. Solver in Excel found a unique integer linear solution that maximized holiday points subject to the constraint that the count of anesthesiologists needed on each holiday was satisfied. A different solution maximized points while also including the constraint that no anesthesiologist works for more than 2 holidays. The total points maximized were slightly less than without the constraint. The group chose the second option with the constraint of equality in days.

The rarity of Huntington's disease (HD) parturients implies that anesthesiologists have little exposure to the management of these patients. We explore techniques for the management of a 21-year-old parturient with symptomatic HD who underwent successful neuraxial anesthesia for labor and subsequent cesarean delivery. We provide guidance on perioperative medications for comorbidities associated with HD. Dexmedetomidine, which we administered neuraxially, appears to have significant potential for the perioperative diminution of choreiform movements. Current anesthetic management of HD cannot be informed by traditional research methodology and therefore much information must be gleaned from the limited available case reports.

Burning mouth syndrome (BMS) is a debilitating intraoral burning or dysesthesia sensation without any evident causative lesions on clinical examination and investigations. The etiopathogenesis of BMS remains uncertain, with proposed mechanisms including psychological, peripheral neuropathic, and central neuropathological factors. Management of BMS is generally symptomatic and often met with poor response. Published data on the successful pain management interventions are inadequate. This report describes the successful management of a 43-year-old patient with severe glossodynia, diagnosed as BMS, using ultrasound-guided suprazygomatic sphenopalatine ganglion block after poor response to the conventional therapies as well as stellate ganglion block.

Malignant hyperthermia (MH) is a rare genetic disorder triggered by inhalational anesthetics or depolarizing neuromuscular blocking agents that carries significant mortality if not promptly treated. The following case presents a healthy 39-year-old man who developed MH several hours into an anesthetic exposure. Rapid intraoperative stabilization tactics that paralleled intensive care unit (ICU) level care allowed for continuation of operative management as opposed to case termination given the patient was at high risk for permanent nerve palsy if the case were to be aborted during dissection.