Immediate onset of postdural puncture headache after spinal anesthesia

134 Journal of Anaesthesiology Clinical Pharmacology | Volume 33 | Issue 1 | January-March 2017 The perioperative anesthetic management is very challenging in patient of tracheal tumor especially with intratracheal mass due to ventilatory concerns and suitable airway gadget for securing airway. Also, the intratracheal mass may get detached and dislodged distally leading to distal airway obstruction.[2] The bleeding during removal may also lead to issues with efficient gas exchange in lungs. Knowledge of the various techniques for airway management is crucial. Planning needs to be discussed among bronchoscopist, surgeon, and anesthetist. Various airway management techniques include ventilation through rigid bronchoscope, tracheostomy, high-frequency jet ventilation, cardiopulmonary bypass, or extracorporeal membrane oxygenation.[3] In our case, tracheostomy was not an option as the tumor was low lying. High-frequency jet ventilation could be other option, but movement of the mass itself can obstruct the airway completely and also risk of barotrauma to lungs is a possibility due to obstructed exhalation.[4,5] Use of cuffed endotracheal tube with cuff placed over the excised area of the trachea provides tamponade action and avoid any oozing of the blood in the postoperative area. We conclude that coring of mass using a rigid bronchoscope along with optimal hemostasis may be life-saving procedure in patients of lower intratracheal tumor with severe respiratory distress.