Anisocoria in the postoperative period may indicate life-threatening conditions, and the possible causes are intracranial pathologies, Horner syndrome, acute angle closure glaucoma, ocular injury, or pharmacological blockade. 1,2We report a unique case of postoperative anisocoria in a patient who underwent cervical spine surgery in a prone position with the patient's head secured on a head clamp.

Pressure sores over bony prominences of heel or sacrum due to positioning are commonly reported, however, the same occurring over malar prominences are rarely seen. We report a case of pressure sore over malar prominence in a patient undergoing surgery in the prone position on horseshoe headrest. These injuries pose a risk of infection, need for surgical intervention, increasing woes, and health cost burden of the patient. Patient care team should aim to prevent such complications by appropriate support device selection, adequate padding, and frequent position changes.

Frontonasal encephalocele is a rare anatomical variant of the meningoencephalocele. Peri-operative anesthesia concerns involve anticipated difficult mask ventilation as well as surgical complications such as compression and rupture of meningoencephalocele. The compression of encephalocele is associated with raised intracranial pressure (ICP) and even rupture of overlying skin leading to cerebrospinal fluid leak, hemorrhage, exposure of underlying frontal lobe, meningitis, seizures, and even death. We report a case of 6-year-old female presenting with rare variant of frontonasal encephalocele for bifrontal craniotomy, excision of encephalocele, and repair. Difficult mask ventilation was anticipated, and patient airway was managed with use of size 4 anatomical mask.

Study Design: Prospective, randomized, placebo-controlled, double-blind exploratory study. Purpose: To compare effects of dexmedetomidine or a subanesthetic dose of ketamine on the amplitude and latency of transcranial electrically generated motor evoked potentials. Overview of Literature: Total intravenous anesthesia (TIVA) is a standard anesthesia technique for transcranial electrical motor evoked potential monitoring in spine surgery. We aimed to determine whether the use of dexmedetomidine and ketamine as a component of TIVA exerted any beneficial effect on the quality of monitoring. Methods: A total of 90 American Society of Anesthesiologist grade I–III patients, aged 18–65 years, with a motor power of ≥4/5 grade as per the Medical Research Council Scale in all four limbs who were scheduled for elective spine surgery under transcranial electrical motor evoked potential monitoring were enrolled. The subjects were randomly allocated into the following three groups: group PD who received 0.5 μg/kg/hr dexmedetomidine infusion, group PK who received 0.5 mg/kg/hr ketamine infusion, and group PS who received normal saline infusion, along with standard propofol–fentanyl based TIVA regime. Amplitude and latency of bilateral motor evoked potentials of the tibialis anterior and abductor halluces muscle were recorded at Ti (at train-of-four ratio >90%), T30 (30 minutes post-Ti), T60 (60 minutes post-Ti), and Tf (at the end of spine manipulation). Results: Baseline median amplitudes were comparable among the study groups. In group PK, we noted a gradually enhanced response by 24%–100% from the baseline amplitude. The median amplitudes of all the muscles were higher in group PK than those in groups PS and PD at time points T60 and Tf (p<0.05). Conclusions: The present study demonstrated that compared with dexmedetomidine and control treatment, a subanesthetic dose of ketamine caused gradual improvement in amplitudes without affecting the latency.

Study Design: Prospective, randomized, placebo-controlled, double-blind exploratory study.Purpose: To compare effects of dexmedetomidine or a subanesthetic dose of ketamine on the amplitude and latency of transcranial electrically generated motor evoked potentials.Overview of Literature: Total intravenous anesthesia (TIVA) is a standard anesthesia technique for transcranial electrical motor evoked potential monitoring in spine surgery. We aimed to determine whether the use of dexmedetomidine and ketamine as a component of TIVA exerted any beneficial effect on the quality of monitoring.Methods: A total of 90 American Society of Anesthesiologist grade I–III patients, aged 18–65 years, with a motor power of ≥4/5 grade as per the Medical Research Council Scale in all four limbs who were scheduled for elective spine surgery under transcranial electrical motor evoked potential monitoring were enrolled. The subjects were randomly allocated into the following three groups: group PD who received 0.5 μg/kg/hr dexmedetomidine infusion, group PK who received 0.5 mg/kg/hr ketamine infusion, and group PS who received normal saline infusion, along with standard propofol–fentanyl based TIVA regime. Amplitude and latency of bilateral motor evoked potentials of the tibialis anterior and abductor halluces muscle were recorded at Ti (at train-of-four ratio >90%), T30 (30 minutes post-Ti), T60 (60 minutes post-Ti), and Tf (at the end of spine manipulation).Results: Baseline median amplitudes were comparable among the study groups. In group PK, we noted a gradually enhanced response by 24%–100% from the baseline amplitude. The median amplitudes of all the muscles were higher in group PK than those in groups PS and PD at time points T60 and Tf (p <0.05).Conclusions: The present study demonstrated that compared with dexmedetomidine and control treatment, a subanesthetic dose of ketamine caused gradual improvement in amplitudes without affecting the latency.

Retinopathy of prematurity (ROP) is a serious morbidity in neonates, which could lead to poor visual outcomes. Data from high-income countries suggest a high incidence of this disease among very preterm neonates.The objective of this study was to evaluate incidence and risk factors of ROP in very-low-birth-weight (VLBW) neonates.VLBW neonates born between January 2015 and July 2018 at Sir Ganga Ram Hospital, New Delhi, were prospectively screened for ROP. The risk factors for ROP were analyzed.Of 461 VLBW infants born during the study period, 361 survived beyond 4 weeks and were evaluated for ROP. Of these, 43 (11.9%) neonates had ROP (any stage) and 8 (2.2%) required treatment with either laser ablation or intraocular anti-vascular endothelial growth factor (anti-VEGF) injections. On multiple logistic regression analysis, lower gestational age, apnea of prematurity, and red cell transfusion were independent risk factors for retinopathy of prematurity.We observed a low incidence of ROP requiring treatment in VLBW neonates. Lower gestation, apnea of prematurity, and red cell transfusions were independent risk factors for ROP.

Background: Neurosurgery during pregnancy is considered a challenge for anesthesiologists due to fetomaternal effects of anesthetic agents. TIVA with adjunct like dexmedetomidine provides optimal condition for neurosurgery, decreases anesthetic requirement, and provides smooth recovery when used in nonpregnant patients although there is limited literature on its use in obstetric patients for neurosurgery.

Pregnancy in Ebstein anomaly could cause acute decompensated heart failure. Therefore, medical termination of pregnancy is the next course of action in such cases. We present a case of 25-year-old primigravida with Ebstein anomaly posted for termination of pregnancy at 8 weeks of gestation. The patient had dyspnea on minimal exertion with a recent episode of upper respiratory tract infection. Caudal epidural in place of lumbar epidural or general anesthesia was chosen in view of the recent episode of respiratory infection and minimal hemodynamic changes and early recovery of motor blockade associated with the former. Pregnancy was terminated successfully with minimal intraoperative hemodynamics variation. Hence, for minor gynecological procedure like termination of pregnancy, caudal epidural anesthesia provides an alternative option especially in cases where hemodynamic variation is least desired like decompensating congenital heart condition.

In this case report, we report the anesthetic management of an emergency cesarean section of a parturient who presented with preterm labor and had inadvertently received rapid intravenous administration of ritodrine.