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the left nasal cavity and advanced smoothly with no signs of epistaxis. Tracheal intubation was performed under direct vision, and according to the Cormack-Lehane classification, the obtained view was grade 2. The ETT was advanced, and intubation completed successfully without difficulty. Thoracic auscultation did not show any abnormal respiratory sounds. Subsequently, an 8-French scale (Fr) enteral feeding tube was inserted through the right nasal cavity and fixed at a position 55 cm from the nostril with no signs of pharyngeal or nasal hemorrhage. Subsequently

fiberoptic approach will often be chosen. While there are many cases in which flexible fiberoptic bronchoscopy may facilitate a safe intubation, it is not without risks. Arguably, the most feared complication of nasotracheal intubation, regardless of the method, is hemorrhage. Blood may completely obstruct the anesthesiologist's view, making intubation very difficult or even impossible. Aspiration of blood may induce pulmonary alveolar damage and lead to severe acute respiratory distress syndrome. 2 Bleeding is more commonly associated with nasotracheal compared

epistaxis. 1 This patient's nasal mucosa near the sphenopalatine foramen was likely damaged during nasotracheal intubation when the tube was guided into the middle meatus, where it compressed the mucosa and caused ischemia. During extubation, the wrinkles on the cuff further damaged the mucosa, 2 causing massive hemorrhage. Airway management during anesthesia is often difficult in patients with massive epistaxis. 3 Although the balloon from a Foley catheter can be placed in the nasal cavity and inflated to control bleeding, its presence can make it difficult to

(height 78.7 cm; weight 8.95 kg). Preoperative examination revealed hemorrhagic diathesis, hypoxemia, and secondary polycythemia. Hemoconcentration (14.6–15 g/dL) due to chronic hypoxemia was confirmed on preoperative examination. Thus, supplemental oxygen was administered via nasal cannula at 0.5 l/min, maintaining the SpO 2 between 80 and 90%. The patient had been on aspirin for antiplatelet therapy, but heparin was substituted prior to the surgery. General anesthesia during the lip repair was induced using sevoflurane (5%), midazolam (1 mg), fentanyl (10 μg

embolic stroke occurs when a blood clot or other debris forms away from the brain and is carried through the bloodstream to lodge in narrower brain arteries. Another cause of stroke is when bleeding occurs into brain tissue from a ruptured blood vessel (hemorrhagic stroke). 3 Stroke is a leading cause of morbidity and mortality. 4 Perioperative acute ischemic stroke is a recognized complication of noncardiac, nonvascular surgery. 5 Among the general population, the rate of acute ischemic stroke in the perioperative period has been reported to be as high as 0

tissue were directly sprayed and irrigated with water or saline. Furthermore, there is the possibility that hemorrhage from the bone surface also washed out the residual anesthetic. In that case, supplemental infiltration anesthesia does not prove efficacious because it leaks easily from the opened flap. Further research is suggested in an attempt to duplicate our findings. Specifically, we will have to compare the residual anesthetic concentration in the bone in both EPF and NEPF procedures after infiltration anesthesia. Another way to obtain these data may be to

if tracheal intubation cannot be completed at that time and there is active bleeding during attempted intubation, the endotracheal tube may be withdrawn and repositioned with the inflated cuff within the postnasal space, to prevent blood passing into the oropharynx and to act simultaneously as a nasopharyngeal airway. An additional option would be to first secure the airway by intubating the patient orally, so that if any problems during the nasotracheal intubation arise, such as massive hemorrhage or difficulty passing the endotracheal

the bleeding with continuous biting on the gauze. Regardless, upon opening of the mouth, massive hemorrhage was observed in the previously stable patient. It appears that gently opening the mouth “in an attempt to improve visualization” during nasal fiber-optic intubation under general anesthesia was not a good choice for 2 reasons. First of all, a standard surgical principle dictates that if bleeding is somewhat controlled despite the presence of a foreign object such as a penetrating knife, steel rod, or packed gauze that may be helping tamponade the bleeding, the