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Unanticipated difficult endotracheal intubations can pose challenges for the anesthesiologist. Risks include airway injury, hypoxemia, and death. There is intubation difficulty in various conditions including Downs syndrome, achondroplasia, acromegaly, and dwarfism. We describe difficulty in intubating the trachea with an appropriate sized endotracheal tube in two young male patients with hypogonadism presenting for neurosurgical procedures under general anesthesia. We discuss the role of hypogonadism and the effects of gonadotropin hormones on pubertal laryngeal growth in male patients.

We report the occurrence of recurrent severe generalized seizures during induction of anesthesia with propofol in a patient with syringomyelia receiving baclofen for flexor spasms undergoing neurosurgery. We discuss the possible epileptogenic interaction between baclofen and propofol in our patient.