Double Outlet Right Ventricle (DORV) with Transposition of Great Arteries (TGA) is a rare variant. The ventriculoarterial discordance due to this anatomical defect leads to parallel circulation. The postnatal survival depends on mixing of oxygenated and deoxygenated blood at various levels by defects like Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA). Anaesthetising children with cyanotic Congenital Heart Disease (cCHD) and brain abscess necessitates use of anaesthesia protocol appropriate to both cCHD and intracranial surgery. Anaesthetic considerations related are maintenance of intravascular volume and preload, avoidance of precursors to acidosis such as hypothermia, hypercarbia, and hypotension and challenge for anaesthesiologist is to maintain Pulmonary Vascular Resistance (PVR) and Systemic Vascular Resistance (SVR) by pharmacological and ventilatory means. This report is about a seven-year-old child who was posted for emergency craniotomy and abscess drainage, after routine preanaesthetic check-up. Induced with fentanyl, ketamine and atracurium, anaesthesia was maintained on oxygen, air and sevoflurane. Intraoperatively, normothermia was maintained, and blood pressure was maintained by noradrenaline infusion, metabolic acidosis was corrected with soda-bicarbonate. In between the procedure, the patient had an episode of Supraventricular Tachycardia (SVT), which was managed with lidocaine, metoprolal and adenosine. In such cases, it is vital to pay attention to any potential anaesthetic interactions.

Scoliosis is a rotational deformity that affects the column in a sagittal plane, a coronal plane and an axial plane. It is a complicated condition that occurs in three dimensions. There are several possible causes, including congenital, neuromuscular or idiopathic. Back pain is the primary complaint; however, it is possible for it to be severe enough to induce additional symptoms, a deficiency in neurologic function or the requirement of surgical intervention.In situations like these, surgery poses a significant danger due to documented consequences, which include serious bleeding and harm to the nervous system, among other things. The preoperative assessment must be extremely thorough and the intraoperative preparation must concentrate on minimising the potential for complications. We present a case of a 20-year female with a complaint of idiopathic scoliosis with difficulty in walking and difficulty in breathing posted for scoliosis correction surgery. The patient was induced under general anaesthesia, the central and arterial line was secured and prone positioning was given, along with continuous neuromuscular monitoring during surgery, somatosensory evoked potential (SSEP) and motor-evoked potential (MEP) were used for monitoring in order to detect impending impairment of the functioning of cerebral and spinal cord motor pathways.

Arnold-Chiari malformation is a very uncommon array of deformities in the posterior part of the cranium and hindbrain caused due to abnormal extension of the posterior brain into the spinal canal. Chiari malformation is further divided into subtypes 1, 2, and 3. The latter two are more common in pediatric forms and present at birth. The severity of symptoms depends upon the extent of herniation of the hindbrain due to herniation of the cerebellum through the foramen of the cranium. Also, there have been instances of absence of cerebellum. Multiple associated disorders like hydrocephalus due to increased intracranial pressure, then encephalocele, syrinx, or spinal deformity in the form of scoliosis have been presented in many cases. All these factors thus become a challenge to anesthesiologists for such patients. Hence evidence-based knowledge along with multidisciplinary, well-planned approach is required for its management.

For an awake craniotomy, a 49 year old (ASA 2), 78 kg woman with type II DM was given regional anaesthesia (scalp block) with monitored anaesthesia care (MAC). She had a headache, which was primarily caused by a left temporal glioma. She was very apprehensive about having this procedure done while she was awake. Fentanyl and Dexmedetomidine infusions in combination with scalp block initially provided adequate operating conditions. Because the patient needed to be fully awake, alert and cooperative during the language and motor mapping, all sedation was turned off. Patient was cooperative and obeyed commands during motor and language mapping as well as during tumour excision. Patient underwent complete excision of tumour without any postoperative neurological deficit. The success of the awake craniotomy  is dependent on the patient cooperation, anaesthesiologist's experience, adequate intraoperative analgesia coverage, careful sedation titration, and meticulous planning.

It is recommended to take a cautious approach when vertebral lesions are discovered in one or two vertebrae but there is no significant disruption in the vertebral stability. We describe a 38-year-old male with Pott's disease of the lumbar spine with extensive psoas abscesses. The patient also had multiple ground glass opacities in right lungs, along with severe aortic regurgitation and mitral regurgitation. The patient was started on anti-tubercular therapy.On the day of surgery, he was induced under general anaesthesia with central venous catheterization and arterial canulation for better haemodynamic management. The abscess was drained in a prone position followed by fixation of the spine. The anaesthetic management was a challenge because of multiple issues the patient had, be it the psoas abscess, extrapulmonary tuberculosis, bad lung mechanics and cardiac changes. An appropriate preoperative assessment and judicious intraoperative planning and management could help us handle the case smoothly. Postoperatively the patient was extubated on the table and shifted to intensive care for observation and further management.