Acute renal failure necessitating the use of CRRT is a rare but serious complication post cardiopulmonary bypass. In the long-term, surviving patients are not likely to require further renal support.

General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.

The study was conducted in eighteen clinical cases of horses for diagnostic and surgical procedures requiring general anaesthesia were randomly divided into three groups, group I, group II and group III, each consisting of six cases. All the horses were premedicated with glycopyrrolate at the dose rate of 0.02 mg/kg body weight, intravenously. Horses in Group I and Group II were administered xylazine hydrochloride at the dose rate of 1.10 mg/kg body weight intravenously, whereas in Group III at the dose rate of 0.50 mg/kg body weight intravenously. In Group III, acepromazine was injected after xylazine administration, at the dose rate of 0.02mg/kg body weight, intravenously. Before induction of anaesthesia, nalbuphine hydrochloride was administered for Group II and Group III at the dose rate of 0.75 mg/kg body weight intravenously. Ketamine hydrochloride was administered intravenously to induce anaesthesia at the dose rate of 2.20 mg/kg body weight and maintained with 0.50 mg/kg body weight in required cases to maintain for duration of 15 ± 1.04 minutes. The mean time for induction in group I, group II and group III were 1.78 ± 0.27, 1.73 ± 0.10 and 1.85 ± 0.28 minutes respectively. The mean total number of additional doses of ketamine for standard duration of 15 ± 1.04 minutes surgery required in group I, group II and group III were 5.00 ± 0.36, 1.66 ± 0.33 and 2.00 ± 0.36 respectively. The quality of induction was 100 per cent smooth in group III, 83.33 per cent smooth and 16.67 per cent rough in group II and 66.66 per cent smooth and 33.34 per cent rough in group I. The quality of analgesia in group I, group II and group III were 2.83 ± 0.47, 1.83 ± 0.30 and 1.33 ± 0.21 respectively. The quality of muscle relaxation in group I, group II and group III were 3.16 ± 0.30, 1.50 ± 0.22 and 1.33 ± 0.21 respectively. The mean time for recovery in group I, group II and group III were 23.00 ± 1.52, 33.00 ± 0.93 and 41.98 ± 1.32 minutes respectively. The mean number of attempts for unassisted standing in group I, group II and group III were 6.66 ± 0.71, 5.00 ± 0.57 and 5.00 ± 0.36 respectively. The quality of recovery was 83.33 per cent smooth and 16.67 per cent rough in group III, 66.66 per cent smooth and 33.34 per cent rough in group II and 50.00 per cent smooth and 50.00 per cent rough in group I. None of the animals in any groups showed any intra and post operative complication.

Aim: A captive male jaguar (Panthera onca) was anaesthetized for surgical excision of a tumor at the left belly fold under xylazine-ketamine immobilization and propofol anesthesia. The objective was to assess the dose of xylazine and ketamine required to abolish ear flick reflex for safe approach when the jaguar was under chemical immobilization and efficacy of propofol induced anesthesia.Materials and Methods: A male jaguar (P. onca) aged 14 years and weighing approximately 90 kg was subjected to chemical immobilization using a combination of xylazine and ketamine using a blow pipe. The jaguar was approached after the absence of ear flick reflex and transported to zoo Operation Theater. Propofol was administered intravenously to induce and maintain anesthesia. The tumor was excised using thermocautery and subjected to histopathology.Results: Ear flick reflex was stimulated at 5 and 10 min after immobilization and observed shaking of head and movement of fore limb following administration of xylazine and ketamine. Dose of xylazine and ketamine required for chemical immobilization, characterized by absence of ear flick reflex was 1.0 and 3.5 mg/kg body weight respectively, and was achieved in 13 min. The surgical plane of anesthesia was maintained for 11 min following administration of propofol at a dose of 2 mg/kg body weight intravenously. The jaguar recovered in 41 min following surgery. The excised tumor was confirmed as sebaceous adenoma on histopathological examination. The animal recovered uneventfully, and no recurrence of the tumor was noticed in 3 months follow-up period. Conclusion:The total dose xylazine and ketamine required for chemical immobilization with absence of ear flick reflex was 1.0 and 3.5 mg/kg body weight respectively. Further, administration of propofol intravenously, at a dose of 2 mg/kg maintained anesthesia for 11 min. Histopathological examination of the excised tumor at the belly fold was confirmed as sebaceous adenoma.

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