Background: Preoperative anxiety and parental deprivation remains a challenge to anesthesiologists.Dexmedetomidine (DexM) has sedative and analgesic effects via central action. Ketamine (KET) is an N-methyl-d-aspartate (NMDA) receptor antagonist that produces a state of sedation. Nebulization is harmless, has rapid absorption, and an inexpensive administration route. The aim of this work was to compare the effectiveness of aerosolized DexM and aerosolized KET as a premedication to general anesthesia in pediatric surgeries. Methods: This prospective double-blind randomized controlled research was carried out on 60 cases of both sexes aged (3-10) years with ASA physical status I, II who were undergoing elective surgery. Cases were divided equally into 3 groups; group D (Dexmedetomidine): received aerosolized dexmedetomidine (3mcg/kg), group K (Ketamine): received aerosolized KET (3 mg/kg) and group C (control): received aerosolized normal saline without drug. Results: Ramsay sedation scale after 15 minutes was insignificant different between DexM and KET, and after 30 minutes was significantly better in DexM than KET. There was significant difference between DexM versus KET with better parental separation and mask acceptance in DexM than KET. There was a significant decrease in the HR before induction of anesthesia in DexM versus KET and controls. There was no significant difference in recovery and discharge time in all groups. Incidence of hypersalivation was significant in KET more than DexM and controls, while incidence of other complications was insignificant among all groups. Conclusions: Aerosolized dexmedetomidine can be used with advantage versus aerosolized KET for preoperative sedation in pediatric surgeries.

Background: This work intended to contrast the effectiveness as well as precision of ultrasound guided coronal versus axial optic nerve sheath diameter (ONSD) measurement in patients at danger of elevated intracranial pressure (ICP). The optic nerve is a tubular structure of approximately 5 cm in Length, in which its intraorbital segment is evaluable sonographically. Methods: The 70 patients in this prospective, randomised, double-blinded trial spanned in age from 18 to 60 and had moderately to grave traumatic brain injury (TBI) when they were transferred to the intensive care unit (ICU) with a GCS of 3-12. There were two groups of patients: Patients in Group A do not exhibit elevated ICP readings on brain CT scans. Group B: Patients who had elevated ICP found on a brain CT scan. Results: There were non-significant higher mean coronal ONSD in comparison to mean axial ONSD in both groups. significant higher mean ONSD and mean axial and coronal ONSD in patients of group B. The Glasgow Coma Scale (GCS) was considerably lower in group B patients. In addition, there was a substantial inverse correlation between the mean ONSD, mean coronal and axial ONSD (mm), and the GCS for patients in both categories. Conclusions: In patients with trauma to the brain, monitoring the diameter of the optic nerve sheath with bedside ocular ultrasonography is a beneficial non-invasive way to detect excessive intracranial pressure earlier and correlation via the two methods (axial and coronal) gives us more accurate measurements.

Coexistence of both intracranial aneurysm and aortic stenosis is quiet rare but it may complicate management of either disease. Managing it is like tug of war, but a good case manager can find that delicate balance. We recently managed patient with severe aortic stenosis presented with anterior communicating aneurysmal.Case-52year old female with complaints of severe headache and vomiting episodes since 10 days. With known case of hypertension and hypothyroid since 4 years on irregular medications posted for aneurysmal clipping. On pre assessment check-up we found pansystolic murmur on auscultation. On investigations it revealed concentric LVH with severe AS with moderate AR maintaining 60% ejection fraction. Other routine investigation were normal. Case was successfully conducted under general anaesthesia with endotracheal tube intubation with pre induction arterial line insertion. Anaesthesia management was tailored keeping in mind hemodynamic stability throughout procedure. With all standard ASA monitoring.

Mitochromatic Leukodystrophy is a progressive degenerative disorder of white matter. Patients with this disease frequently require anaesthesia for various diagnostic and surgical procedures. These patients pose a lot of anaesthetic problems like seizures, spasticity, risk of aspiration, and copious secretions, in addition to other organs dysfunctions. Our case report is about provision of general anaethesia for a female child for laparoscopic cholecystectomy and gastrostomy tube placement.

The airway management of syndromic pediatric patients is an ongoing challenge for the anesthesiologist. The craniofacial abnormalities and multiple system anomalies in Edward syndrome children require special consideration during the perioperative period. We hereby report the successful airway management of an 8-year-old male child with Edward’s syndrome posted for laparoscopic orchidopexy.

Objective: This study was conducted to compare the efficacy of Propofol with Ketamine versus Propofol with Fentanyl for procedural sedation for patients undergoing ERCP to evaluate Propofol consumption, recovery score, patient satisfaction and sedation related adverse events. Materials and Methods: Sixty patients aged 18-60 years, ASA Class I and II were randomly allocated to one of two groups; Propofol/Ketamine (Ketofol) group KP (n=30) and Propofol/Fentanyl group FP (n=30). The level of sedation was adjusted to achieve a Ramsay Sedation Scale (RSS) score of 5. Results: The total amount of Propofol consumed was significantly higher in FP group (109.883±11.3871 mg) compared to KP group (89.867±9.8942 mg). Time to reach acceptable recovery score was slightly longer in KP group compared to FP (Aldrete scores 9.5±0.509, 9.8±0.407 respectively at 30 min). Patient satisfaction was comparable in both the groups and sedation related side effects like hypotension, bradycardia, desaturation was more significant in FP group compared to KP group. Conclusion: Propofol-Ketamine combination provided sedation quality similar to Propofol-Fentanyl combination with better hemodynamic profile and fewer side effects. Hence Propofol-Ketamine combination can be safely used in patients undergoing ERCP.

Poor peristalsis and an inability to relax the lower esophageal sphincter are symptoms of achalasia cardia, a chronic neurodegenerative motility condition of the oesophagus. (LES). The primary problem with remedial operations for achalasia cardia is pulmonary aspiration of esophageal residual contents during induction of general anaesthesia. The timing of nil per oral or endoscopic clearance of esophageal contents prior to induction of anaesthesia is not governed by any universally accepted standards. We present the case of a 43-year-old man with a history of hypertension, diabetes, and myocardial infarction who underwent surgery to repair his sigmoid oesophagus. The patient was optimised before the anaesthesia was administered in accordance with the current standard of care. The patient's stay was uneventful, and there was no sign of aspiration during the operation. Aspiration during general anaesthesia was avoided by carefully optimizing the patient beforehand.

Patients with known case of dilated cardiomyopathy (DCMP) undergoing major open abdominal surgery under general anaesthesia poses a challenge for anesthesiologist. It is because in such surgeries there is risk of precipitating congestive heart failure. Also major haemodynamic instability due to major fluid shift. Here we report a successful case management of patient with dilated cardiomyopathy posted for exploratory abdominal surgery under general anaesthesia.

Background: An effective interfascial plane block for laparoscopic (lap) cholecystectomy and other abdominal procedures is the Quadratus Lumborum Block type II (QLB-II). The erector spinae plane block (ESPB), which is guided by ultrasound (US), is a recently described interfascial plane block that is gaining popularity. This research aims to evaluate the relative effectiveness of ultrasound ESPB and US QLB in the treatment of immediate post-operation pain following lap cholecystectomy.Methods: Sixty cases (21-65 years old, from both sexes) having elective lap cholecystectomy were enrolled in this prospective randomized double-blind research. The cases were randomly classified into three equal groups, C group: received general anesthesia (GA) only, ESPB: received GA and bilateral US ESPB and QLB: received GA and bilateral US QLB.Results: Duration of performing block was significantly less in group ESPB versus group QLB. Intraoperative heart rate and mean arterial pressure were significantly less after incising the skin, at 30 min in ESPB and QLBs versus group C. Total fentanyl dosage and morphine dosage in 1st 1 day were significantly less in group ESPB and QLB versus group C. NRS at 6, 24 hour was significantly less in ESPB and QLBs versus group C. First time to call for analgesic requirement was significantly delayed in the ESPB and QLBs versus the C group. Conclusions: The ESPB is as efficient as posterior QLB to provide effective analgesia as comparable results of lower NRS, intraoperative fentanyl and post-operation opioid dosage, delayed first time to call for analgesic requirement and is lower side effects versus control in cases undergoing elective laparoscopic cholecystectomy.

The pituitary gland undergoes global hyperplasia during pregnancy. Pituitary tumour cells in patients with prolactinoma and that with growth hormone secreting tumour exhibit symptomatic enlargement during pregnancy, either due to the growth promoting effect of oestrogens or due to the high levels of circulating Progesterone that occur with gestation. Based on their size prolactinoma (>1cm) or microadenoma microadenoma are classified into macroadenoma with severe pregnancy induced hypertension posted for emergency Caesarean section under epidural anaesthesia. Here we present successful anaesthetic management of patient with pituitory microadenoma with severe pregnancy induced hypertension posted for emergency Caesarean section under epidural anaesthesia.