Congenital long QT syndrome (LQTS) is a rare genetic disorder that has been associated with various genetic mutations including life-threatening cardiac arrhythmias and sudden death. Left thoracoscopic sympathectomy is an effective treatment for patients who are refractory to medical therapy or who need frequent epicardial internal cardio defibrillator intervention. The authors report three cases, one adult and two children, who underwent successful left thoracoscopic sympathectomy. All three patients remained clinically stable without arrhythmias through 3 months of follow-up. It is suggested in the literature that 77% of patients experienced immediate relief of symptoms. The results of this case report suggest that left thoracoscopic sympathectomy is a safe and effective approach for treating patients with LQTS.

Arteriovenous (AV) malformations of the face are rare presentations. Endovascular coiling is one of the treatment modalities. We report a case of a 65-year-old lady who presented with a large AV malformation of the face located around the nasal bride and alae nasae posted for coiling under general anesthesia. Anesthetic management of the case was a challenge as it was an anticipated difficult airway situation. Furthermore, any pressure on the swelling can lead to rupture and hemorrhage as the skin above swelling was unhealthy. There was difficulty in mask ventilation both with larger- and smaller-sized facial masks including Rendell-Baker-Soucek mask. Supraglottic airway device had to be inserted as a rescue measure. After getting effective ventilation, muscle relaxants were supplemented, and trachea was intubated. While intubating the axis of the laryngoscope had to be maintained on the right side to avoid pressure on the swelling as it could traumatize the malformation. The procedure went on uneventful. The patient was extubated fully awake.

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Background & objective: We studied the safety and effectiveness of combination of dexmedetomidine and fentanyl for chronic sub-dural hematoma (CSDH) evacuation. Main objectives of the study was to register the effects on the combination on the cardio-respiratory and analgesic outcome. Methodology: 56 patients with CSDH were divided into two group. Patients of Group A received dexmedetomidine 1 µg/kg over a period of 10 min with fentanyl 1 µg/kg, followed by an infusion of dexmedetomidine 0.3 µg/kg/min. Group B received fentanyl 1 µg/kg and midazolam 0.03 mg/kg IV. Sedation scores, hemodynamic changes and serial arterial blood gas (ABG) measurements were compared between the two groups. Results: Heart rate and diastolic blood pressure were significantly lower in Group A compared to Group B throughout the observation period after premedication. Systolic blood pressure readings was significantly lower in Group A compared to Group B from 10 min onwards till the end. ABG analysis showed that Group A had significantly lower PCO2 levels during and at the end of surgery and significantly higher PO2 at the end of procedure. Conclusion: The use of dexmedetomidine is associated with significantly higher PO2 at the end of the surgical procedure. It results in lower heart rate, systolic and diastolic blood pressures and PCO2 levels during and at the end of the subdural hematoma evacuation, but the fall remains within the physiological range.

IntroductIonDexmedetomidine is a highly selective α-2 adrenoceptor agonist commonly used in anesthesia practice. Dexmedetomidine produces sedation, hypnosis, analgesia, anxiolysis, and sympatholysis with minimal respiratory depression. [1] The central effects are due to the activation of α-2A receptors in locus coeruleus, and cardiovascular effects are due to a dose-dependent decrease in the central sympathetic outflow. The transient hypertensive response is seen initially due to its effects on α-2B receptors present in the vascular smooth muscle until there is a decrease in the central sympathetic outflow. [2] Dexmedetomidine has been shown to reduce perioperative oxygen consumption and blunt the sympathetic response to laryngoscopy and surgical stimuli, resulting in improved cardiac outcomes. [3,4] Dexmedetomidine infusions postoperatively have been shown to reduce plasma catecholamine levels and lesser hemodynamic fluctuations. [5] Dexmedetomidine has also been shown to reduce anesthetic and analgesic requirements. [6,7] The above-stated properties make dexmedetomidine an ideal preanesthetic agent. A study demonstrated that single preanesthetic dose of dexmedetomidine decreased the thiopental dose requirement without any serious hemodynamic changes. [7] Objective: To find out the dose of propofol consumption for induction and also the variation in hemodynamics following single-dose dexmedetomidine premedication. Methods: A total of 60 American Society of Anesthesiologists Class 1 and 2 patients aged between 18 and 80 years, posted for elective surgeries were randomized into two groups: Group C -premedication with 2 mcg/kg fentanyl and Group D -premedication with 1 mcg/kg dexmedetomidine + 2 mcg/kg fentanyl. Both groups were preloaded with 10 ml/kg crystalloid solution. The parameters measured were propofol requirements, heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), cardiac output (CO), and stroke volume variation (SVV). Results: Propofol requirements were 26.6% lesser in Group D (P < 0.001). In Group C, HR was significantly low at baseline (P = 0.008), induction (P = 0.006), and at intubation (P = 0.001) in Group D. Cardiovascular parameters such as MAP (P = 0.007), CI (P = 0.038), and CO (P = 0.021) were significantly lower in Group D compared to Group C only at baseline. There were no differences at any other point during the study. SVV was noted to be significantly lower (P = 0.018) in Group D only at intubation. Conclusion: Dexmedetomidine decreases the requirements of propofol for induction and also attenuates the hemodynamic response to intubation. Cardiovascular parameters such as MAP, CI, and CO were significantly lower in Group D only at baseline. Hemodynamic stability is mainly attributed to adequate preloading and less propofol requirement in the dexmedetomidine group.

BACKGROUND Post dural puncture headache (PDPH) has been the most common complications of spinal anaesthesia especially in obstetric patients. After needle gauge, tip design is an important factor determining rate of incidence of post dural puncture headache. Aim-Comparison of incidence of post dural puncture headache with 25 gauge quincke and 25 gauge whitacre needle in obstetric patients MATERIALS AND METHODS Total of 80 patients posted for caesarean section were divided in two groups each comprising 40. Group A-spinal anaesthesia with 25 gauge quincke needle, Group B-spinal anaesthesia with 25 gauge whitacre needle. Patients were observed for level of sensory blockade, bromage score, incidence of hypotension, shivering, nausea, vomiting and development of PDPH post spinal anaesthesia RESULTS Incidence of PDPH found was 5% in group of quincke needle and was absent in group of whitacre needle. Other parameters were similar and comparable in both groups but bromage score was higher in quincke group than whitacre. CONCLUSION No significant difference was found in incidence of PDPH in both needle groups in obstetric patients. Quincke needle group was found to be associated with higher bromage score than whitacre needle group.

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