Epilepsy surgeries can be done under general anesthesia or with local anesthesia and sedation. Epilepsy surgery done under general anesthesia have similar goals as any other neurosurgical procedure, except in patients with temporal lobe epilepsy requiring cortical mapping or electrocorticography (ECoG) where depth of anesthesia has to be reduced. Since seizure focus localization can be done preoperatively with modern diagnostic tools, general anesthesia is popular even for these patients. It is comfortable for both the surgeon and the patient. For intraoperative ECoG or cortical mapping awake craniotomy is the preferred technique.

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Background and Aims:Scalp blocks combined with general anaesthesia reduce pin and incision response, along with providing stable perioperative haemodynamics and analgesia. Clonidine has proved to be a valuable additive in infiltrative blocks. We studied the efficacy and safety of addition of clonidine 2 μg/kg to scalp block with 0.25% bupivacaine (Group B) versus plain 0.25% bupivacaine (Group A) for supratentorial craniotomies.Methods:Sixty patients were randomly divided into two groups to receive scalp block: Group A (with 0.25% bupivacaine) and Group B (with 0.25% bupivacaine and clonidine (2 μg/kg). Bilateral scalp block was given immediately after induction. All the patients received propofol based general anaesthesia. Intraoperatively, propofol infusion was maintained at 75 to 100 μg/kg/h up to dura closure and reduced to 50-75 μg/kg/h up to skin closure with atracurium infusion stopped at dura closure. Heart rate (HR) and mean arterial pressure (MAP) were monitored at pin insertion, at 5 minute intervals from incision till dura opening and again at 5 minute interval from dura closure up to skin closure. Fentanyl 0.5 μg/kg was given if a 20% increase in either HR and/or MAP was observed. Postoperative haemodynamics and verbal rating scores (VRS) were recorded. When the VRS score increased above 3, rescue analgesia was given. Any intraoperative haemodynamic complications were noted.Results:Group A showed a significant increase in haemodynamic variables during the perioperative period as compared to group B (P < 0.05). Addition of clonidine 2 μg/kg in the infiltrative block also provided significantly prolonged postoperative analgesia.Conclusions:Addition of clonidine to scalp block provided better perioperative haemodynamic stability and significantly prolonged analgesia.

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ACCUFLOW is a low cost device that can be used to adjust and monitor the infusion flow rate. The alarm would alert the nursing staff when there is deviation from the preset rate of infusion. ACCUFLOW could thus be an attractive option for infusion rate monitoring in developing countries with limited healthcare resources and skewed patient nurse ratios. However applicability to infants and younger children and for longer infusions needs to be determined.

Background and Aims:Neuromuscular blocking agents have been one of the cornerstones of anaesthesia. With the advent of newer surgical, anaesthetic and neurological monitoring techniques, their utility in neuroanaesthesia practice seems dispensable. The aim of this prospective, comparative, randomised study was to determine whether neuromuscular blocking agents are required in patients undergoing supratentorial surgery when balanced anaesthesia with desflurane, dexmedetomidine and scalp block is used.Methods:Sixty patients with the American Society of Anesthesiologists physical status I or II, aged between 18 and 60 years were included in the study. All patients received anaesthesia including desflurane, dexmedetomidine and scalp block. The patients were randomly allocated to receive no neuromuscular blocking agent (Group A) or atracurium infusion to keep train-of-four count 2 (Group B). The two groups were compared with respect to haemodynamic stability, brain relaxation scores and recovery characteristics. Haemodynamic parameters and time taken to achieve Aldrete score >9 and other secondary outcomes were analysed using Student's t-test. Non-parametric data were analysed using the Mann–Whitney test.Results:The mean arterial pressure was comparable between the groups. The intraoperative heart rate was comparable; however, in the post-operative period, it remained higher in Group B for 30 min after extubation (P = 0.02). The brain relaxation scores were comparable among the two groups (P = 0.27). Tracheal extubation time, time taken for orientation and time required to reach Aldrete score ≥9 were comparable among the two groups.Conclusion:The present study suggests that balanced anaesthesia using desflurane, dexmedetomidine and scalp block can preclude the use of neuromuscular blocking agents in patients undergoing supratentorial surgery under intense haemodynamic monitoring.

was a secondary progressive decline to a lower plateau of +8.061.8 mm Hg (p¼0.004), Abstract 004 figure 1. The initial increment was caused by an immediate rise in flow by +9.162.4% (p¼0.007) which did not drop later. The secondary decline in pressure was caused by a delayed gradual decline in total peripheral resistance. Finometer-derived non-invasive blood pressure tracked invasive pressure closely (r¼0.97). Conclusion When AV delay is made more favourable, only the instant pressure increment is caused by increase in stroke volume. The secondary pressure decline is caused by systemic vasodilatation. Design of AV optimisation protocols, which face severe challenge of signal vs noise, might benefit from recognition that not all beats are equally informative: the first few after a transition are most signal-rich. Introduction A significant number of patients undergoing Cardiac Resynchronisation Therapy (CRT) do not remodel. Assessing global dyssynchrony has the potential to improve patient selection. We developed a framework for comparing measures of myocardial motion from cardiac magnetic resonance (CMR) imaging and evaluated the potential of these techniques to improve patient selection. Methods 48 patients recruited, (43 males, 63.8613.9 years), NYHA class 2.960.5, ejection fraction 2569%. Patients had LBBB (QRS 154624 ms). Acute haemodynamic response was measured at time of implant with a pressure wire in the LV measuring change in dP/ dt max . A >10% increase in LV-dP/dt max from baseline was considered an acute response. Decrease in end systolic volume (ESV) $15% at 6 months was used to determine remodelling. CMR was performed prior to CRT. A novel framework was developed. Key steps included: (1) detection of heart and myocardium segmentation from anatomical CMR cine images; (2) detection of endo and epi-cardial surfaces for wall thickening computation; (3) extraction of deformation fields within the myocardium for strain computation. A systolic dyssynchrony index (SDI) was produced for all parameters which included volume change, muscle thickening, radial, circumferential, longitudinal strain and combined strain. High SDI denoted dyssynchrony. Results Pre-implant ESV 175664 ml, post-implant ESV 155668 ml (p<0.01). 20 (44%) patients remodelled. We found a strong relationship between volume derived SDI and acute response (p¼0.008) and remodelling (p<0.001) (Abstract 005 figure 1). We found a weaker relationship with remodelling and muscle thickening SDI (p¼0.001) and no relationship with a SDI derived from strain indexes (Abstract 005 figure 2). Volume SDI $10% was highly sensitive (0.94) and specific (0.87) for predicting remodelling. Volume SDI was far superior for predicting remodelling than any other method. The intra-observer average difference for volume SDI Abstract 005 Figure 1 Shows the ANOVA plots for acute response and remodelling for QRS duration, volume and muscle thickening derived SDI. 005Abstract 005 Figure 2 Shows the ANOVA plots for acute response (top row) and remodelling (bottom row) for ...

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