Induction of anesthesia in patients with giant type IV hiatal hernia can precipitate aspiration, difficult ventilation, and hemodynamic compromise. We describe a preoperative computed tomography-guided awake right-sided double-lumen tube (DLT) intubation strategy using layered topical airway anesthesia and light cooperative amnestic-analgesic sedation, with neuromuscular blockade delayed until after airway control. Transcutaneous electrical acupoint stimulation (TEAS) was applied during the pre-intubation preparation period. A 53-year-old woman tolerated awake DLT placement without cough, desaturation, or hemodynamic instability. This case emphasizes structured airway planning and preserved spontaneous ventilation in selected high-risk patients, but the independent role of TEAS remains hypothesis-generating.
Anesthetic management of pregnant patients with chronic myeloid leukemia (CML) is complicated by concerns that neuraxial techniques could theoretically introduce leukemic cells into the central nervous system. Evidence guiding anesthetic decisions in chronic-phase CML without circulating blasts is limited. We describe two pregnant patients with CML in whom anesthetic management was individualized based on disease status and obstetric risk. Systemic analgesia was chosen when molecular relapse raised concern for occult blasts, whereas spinal anesthesia was performed in deep molecular remission when maternal comorbidities increased the risk of general anesthesia. Both patients had uncomplicated deliveries, with molecular remission confirmed at 1-year follow-up.
