Although rare, a change in visual acuity after surgery for nonocular procedures has devastating consequences. Increased recognition and discussion of this complication is reported in recent literature, most notably following spinal and cardiac surgery. Various pathologies may be responsible for perioperative visual loss (POVL), including ischemic optic neuropathy, retinal vascular occlusion, and cortical blindness. Here we review the incidence of the problem, the anatomy and physiology of the ocular circulation, variants of POVL, and proposed predisposing factors. Potential perioperative methods to prevent this complication are discussed, and suggested treatment modalities are presented.

Local anesthetic-associated cardiac toxicity following caudal epidural blockade is, fortunately, a rare event. Prompt recognition and early treatment is the key to successful resuscitation. Early use of the lipid emulsion Intralipid in bupivacaine-induced cardiac toxicity may lead to a good outcome.

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Patients with impaired ability to understand and communicate can be difficult to manage perioperatively. They frequently require lateral thinking on the part of the anesthesiologists to make the induction process as smooth as possible. We present a case of a severely autistic and violent patient scheduled for dental rehabilitation under general anesthesia. A combination of oral ketamine and midazolam was mixed in the beverage Dr Pepper to mask the taste and the appearance of the drugs. The unique flavor of Dr Pepper is well suited to increase the palatibility and the acceptability of medications in children and patients with developmental delay.

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Ten days after the first surgery, he was posted for thoracoscopic excision of hydatid cyst on the left side. After aspiration of the cyst, 100 ml of 3.5% hypertonic saline was instilled into the cavity. Following use of hypertonic saline, blood pressure rose to 200/100 mmHg, pulse 160 bAEmin )1 , serum Na 152 mmolAEl )1 . We administered 2 mg frusemide and withheld further administration of sodium containing solutions. The blood pressure returned to baseline in about 20 min. The rest of the intraoperative course was uneventful. Postoperative chest radiograph showed good expansion of both lungs (Figure 2).Severe hypernatremia after hypertonic saline irrigation has been reported (3). We caution the use of hypertonic saline for irrigation of hydatid lesions. Frequent and regular monitoring of intraoperative sodium and prompt correction of hypernatremia may prevent adverse neurological sequelae (4).Although one lung ventilation is recommended for cystic lesions of the lung, in case of bilateral lesions conventional two-lung ventilation would be safer in view of possible rupture of the cyst on the ventilated side.

Angioedema is a rare adverse reaction of carbamazepine, which causes localized tissue edema in submucosal and subcutaneous tissue mediated by histamine, serotonin, and kinins (bradykinin). We report a case of 34-year-old female who developed angioedema, 24 h after administration of carbamazepine for treating bipolar disorder. Patient's symptoms responded rapidly with antihistamine therapy and with the withdrawal of carbamazepine, the offending drug. Carbamazepine-induced angioedema is a life-threatening reaction which requires immediate treatment and monitoring in order to avoid morbidity and mortality.

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