This case series reviews surgeries involving elderly patients with femoral neck fractures on apixaban who underwent spinal anesthesia (SA) within 72 hours of their last dose. Despite patients being on anticoagulation, no neurological complications occurred, suggesting SA may be practical in cases where the benefits of timely surgery outweigh the potential risks, including apixaban discontinuation for a period of less than the recommended 72 hours with detectable levels of the drug remaining in the plasma. Quantitative apixaban measurements offered useful anticoagulation status insights, though safe thresholds remain undefined.

Nasotracheal intubation is a commonly used technique in elective oral and pharyngeal surgeries. This case report details an incident involving a young adult patient in which an attempt at nasotracheal intubation resulted in a life-threatening cervicofacial and thoracic emphysema. Although complications associated with nasotracheal intubation are rare, their potential severity necessitates a comprehensive preprocedural discussion and risk assessment with the surgical team to confirm its appropriate indication for each individual patient. This case underscores the need for increased awareness and readiness for managing rare but critical complications associated with airway management techniques.

The Accreditation Council for Graduate Medical Education defines "nonphysician obligations" as "duties performed by nursing and allied health professionals, transport services, or clerical staff." How anesthesiology trainees understand the concept of "nonphysician obligations" and are impacted by these obligations is incompletely understood. The objective of the study was to identify how anesthesiology trainees define "nonphysician obligations," which obligations impact trainee education, and what attitudes trainees hold. A survey was administered to Anesthesiology residents (N = 86) at a large academic hospital in 2023. Respondents defined "nonphysician obligations," listed obligations that impacted their education, and indicated the frequency of these obligations. Respondents scored their agreement with statements appraising attitudes toward the clarity and consistency of the term and classified anesthesiology tasks as physician/nonphysician. The authors developed a conceptual framework defining "nonphysician obligations" using grounded theory and categorized the participants' responses based on this framework. Tallies assessed which obligations and attitudes were most prominent. The response rate was 82.6% (n = 71). Respondents defined nonphysician obligations with either a patient-centered or physician-centered framework. Tasks spanning nursing, patient transport, anesthesia technicians, certified registered nurse anesthetists, and care coordinators impacted education most. Outlier definitions and obligations emerged, including personal and household obligations. Fifty-seven percent of trainees disagreed that the definition of nonphysician obligations was clear. Forty-seven percent agreed definitions held by anesthesiology trainees were aligned. Sixty-two percent felt that different medical specialties did not share a common definition. Classification of typical anesthesiology tasks as physician/ nonphysician was heterogenous. "Nonphysician obligations" are defined by a new, nuanced, specialty-specific explanatory framework, and those that impact education are summarized in distinct classes. Trainee definitions and attitudes expose possible faults in how nonphysician obligations are currently evaluated.

Inappropriate sinus tachycardia (IST) presents challenges in diagnosis and treatment due to its unclear etiology and limited therapeutic options. This case report explores the use of continuous stellate ganglion block (CSGB) as a potential treatment avenue. A 23-year-old woman with refractory IST underwent several CSGB placements, resulting in prolonged symptom relief and decreased median heart rate. Despite the eventual recurrence of symptoms, the sustained effects of CSGB suggest its efficacy in managing IST. This report underscores the potential of CSGB as a promising therapeutic approach for IST, offering longer-lasting symptom control compared to single-injection stellate ganglion block (SGB) interventions.

The circle breathing system enables rebreathing using a carbon dioxide absorbent. This case report presents a rare incident of ventilation failure in a 30-year-old male patient due to a broken unidirectional valve in a soda lime canister. Despite the anesthesia machine passing automated checks, a mechanical blockage from caked soda lime in the inner inspiratory chamber led to insufficient tidal volume delivery. The incident underscores the importance of performing manual breathing circuit checks after replacing the soda lime canister, as well as the need for heightened vigilance in detecting equipment malfunctions to maintain patient safety during anesthesia.

PHARC syndrome (polyneuropathy, hearing loss, ataxia, retinitis pigmentosa, and cataracts) is a rare autosomal recessive disease, caused by genetic mutation of the ABHD12 gene. This syndrome is still not well known and can be misdiagnosed, especially in the early stages, as it can be easily confused with other neurodegenerative diseases. We present the first description of the anesthetic management of 2 siblings with PHARC syndrome who underwent unilateral cochlear implantation.

The study aimed to evaluate the effectiveness of deep subgluteal block (DSGB) for pain relief after posterolateral-approached total hip replacement. The cadaver study and observational case series assessed the spread and outcomes of ultrasound-guided DSGB. Results showed low postoperative pain scores, minimal opioid requirements, and no complications related to DSGB. Anatomical dissection revealed effective spread of the injected substance. These findings suggest that DSGB could be a promising regional analgesic technique for postoperative pain management after posterolateral-approached total hip replacement.

A 71-year-old woman with coronary artery disease presented for carotid artery revascularization. After general anesthesia, the patient arrived in stable condition to the postanesthesia care unit. While awaiting transfer to her inpatient room, telemetry alarms alerted her nurse, who found the patient unresponsive, cyanotic, and pulseless. Advanced cardiovascular life support was initiated, with return of spontaneous circulation obtained after 1 round of chest compressions. On oropharyngeal examination, food particles were observed and suctioned. The patient then coughed up additional cracker pieces. This case highlights the risk of aspiration from dry, solid foods in the elderly during the postanesthesia recovery period.