A 33-year-old female presented with an extremely rare case of chronic spinal subdural hematoma in the cervicothoracic region manifesting as sudden onset of flaccid paraplegia and urinary retention. She was receiving warfarin medication for an episode of superior sagittal sinus thrombosis 2 years earlier. Two months previously, she had undergone a minilaparotomy under general anesthesia following unsuccessful spinal anesthesia. Magnetic resonance imaging showed a large cervicothoracic extramedullary mass causing cord compression. However, laminectomy for excision of mass revealed a purely subdural hematoma. Her neurological deficits were partially resolved after removal of subdural hematoma.

Background:Cost and environmental pollution are two prime concerns with general anesthesia. We hypothesized that target-controlled (TC) anesthesia drug delivery system also called as end-tidal (ET) control is an effective and safe system that would reduce the cost and also environmental pollution.Materials and Methods:We studied 200 patients undergoing laparoscopic abdominal and pelvic surgeries and randomly distributed those in 2 groups of 100 each, TC and manual-controlled (MC) group. We reviewed the two groups in term of consumption of gases, time required to achieve the ET concentration of sevoflurane of 1.5%, maximum inspired concentration of sevoflurane achieved, and number of adjustments required to maintain the depth of anesthesia.Results:We found that the consumption of nitrous oxide and sevoflurane was significantly less in TC group than MC group (P < 0.05), oxygen consumption was also less in TC group but not statistically significant. The time required to achieve the desired levels, maximum inspired sevoflurane concentration achieved, and the number of drug delivery adjustments required were statistically significant in TC group (P < 0.05). As the consumption reduced in TC group, the cost of the inhalational anesthesia reduced by approximately Rs. 64/h ($1.12) and thus the environmental pollution.Conclusion:We concluded from our study that ET control is a good system for conserving the consumption of gases and thus is efficient as it reduces both the cost and the environmental pollution.

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