Transplantation provides a near normal life and excellent rehabilitation compared to dialysis and is preferred method of treatment for end stage renal disease patients. After ethics committee approval, a retrospective analysis of recipients of renal transplantation was done at our hospital from January 2010 to December 2014. Preoperative patient status, fluid management, hemodynamic parameters, anesthesia management, and perioperative complications were recorded and analyzed.Total 100 patients were recorded, 92% living and 8% were cadaveric related transplant. 92% were done electively. Most common co-morbidity recorded was hypertension in 49% patients. Predominant cause of end stage renal disease was chronic glomerulonephritis (41%). General anesthesia was technique of choice in all patients, 27 also received epidural. Invasive blood pressure monitoring was done in 3 patients with cardiac co-morbidities. 15% patients required blood transfusion. CVP maintained > 12 mmHg and maximum at de-clamping. Mean arterial pressure maintained above 95 mmHg. Ionotropic support required in 2 patients. 76% patients were transfused with only crystalloid (NS and/or RL) while 24 patients received a combination of both crystalloid and colloid. 97% patients were extubated postoperatively while 3% required ventilator support. Recovery time with desflurane was significantly less as compared to other inhalational agents. One patient died postoperatively. Recent advances in surgical techniques, anesthesia management and immunosuppressive drugs have made renal transplantation safe and predictable. Preoperative patient optimization, intraoperative physiological stability and postoperative care of renal transplant patients have contributed to the success of renal transplant program in our hospital.

We present a case of unusually prolonged motor and sensory block for 30 hours after a successful single injection of ultrasound-guided interscalene block with 0.5% plain bupivacaine. All safety measures such as negative aspiration of blood injection at every 3 mL of drug with usual resistance, slow rate of injection and ultrasound documentation of spread of drug around C 5 and C 6 were followed. There was no evidence of neurological injury, but we should always be prepared to consider the possibility of nerve injury and take appropriate measures to prevent them.

Congenital complete heart block in pregnancy is rare. Fetal distress permits no time for neuraxial blockade. Twenty-two years antenatal clinic diagnosed atrioventricular dissociation and complete heart block at 6 months of pregnancy, presented with fetal distress at 36 weeks. General anesthesia was given with transcutaneous pacemaker standby. Healthy baby was delivered. One episode of bradycardia occurred which responded to Inj atropine 0.6 mg IV however blood pressure was stable. We managed lower segment cesarean section (LSCS) in complete hearth block with fetal distress uneventfully with general anesthesia.

Neurological deficit post central neuraxial blockade is rare but considered for highest compensation. We present a case of S1 mononeuropathy presented as foot drop after combined spinal epidural. A 30-years-old male with lower limb fracture was posted for plating. Patient was ASA grade I and all his investigations were normal. Combined spinal epidural was planned. The procedure was performed following all standard operating procedures. Surgical procedure was uneventful, epidural catheter was removed 12 hours postoperatively. 24 hours postoperatively foot drop was noted. Patient was evaluated by neurologist. Ankle dorsiflexion power-1/5, extensor hallucis longus and extensor digitorum brevis were weak. MRI spine was done, which was normal. Neurologic impairment after subarachnoid block is rare, but multifactorial. The causes can be divided into iatrogenic or idiopathic. In some cases it could be a coincident to clinical presentation of any other organic disease. Trauma by the needle or catheter are the commonest causes for the neurological deficit. Regular follow-up and supportive treatment is important in these patients. Medicolegal issues is a big worry in such cases.

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