Background and Aims:Post-operative pain is a major concern for day care surgeries like laparoscopic cholecystectomy. This study aimed to compare the efficacy of ultrasound guided abdominal field blocks (USAFB) with port site infiltrations for post-operative analgesia in terms of quality of pain relief, opioid consumption and patient satisfaction for day care surgeriesMethods:Eighty patients presenting for laparoscopic cholecystectomy were randomly allocated to two groups either to receive port-site infiltration of local anaesthetic (n = 40, Group A) or USAFB (n = 40, Group B group). Numeric rating scores (NRS) were measured postoperatively to primarily assess the pain severity and opioid requirements. Data were analysed using Chi-Square test/Fisher's exact test for categorical data and Mann–Whitney test/unpaired t-test for quantitative data.Results:The study group (Group B) had significantly reduced NRS and opioid consumption over 24 h. The overall fentanyl consumption in patients receiving port infiltrations was approximately twice (200 ΁ 100 μg) as compared to patients in USAFB group (120 ΁ 74 μg) (P < 0.0001). Maximum fentanyl consumption was 400 μg (Group A) and 262 μg (Group B) over 24 h and the minimum requirement was 50 μg and zero, respectively.Conclusion:Superior post-operative analgesia was observed with USAFB which may help in minimising opioid-related adverse effects and facilitating faster recovery.

No abstract

Anesthesia for partial glossectomy in a premature child with Beckwith-Wiedemann syndrome presents as a unique challenge to the Anesthesiologist. Airway management in patients presenting with macroglossia is especially significant and requires meticulous preparation and pre-operative assessment. This report delineates the anesthetic concerns such as an anticipated difficult airway due to a large tongue, prematurity, hypoglycemia and an oral cavity surgery and their management.

Perioperative management of conjoined twins is extremely difficult. The unique anatomical and physiological considerations pose a challenge to the entire operating team including the anaesthetist. The complexity of surgical technique, length of operation, risk of hypothermia, changes in fluid, electrolyte and acid-base balance require meticulous planning, appropriate resources and a dedicated team effort. We report successful separation of pygopagus conjoined twins at our institution and discuss the perioperative management.

Purpose: Diagnosis and perioperative management of bilateral adrenal pheochromocytoma with a successful outcome is an apt combination of clinical knowledge and anaesthetic skills. Detailed history, meticulous physical examination, relevant laboratory investigations along with good preoperative pharmacological optimization and fluid resuscitation plays an important role in the perioperative period. Genetic testing and counseling should be offered to all the family members of patients suspected of familial predisposition. We report the anesthetic management of 10 year old male child with bilateral adrenal pheochromocytoma with family history of disease. Clinical Features: A10-year old male, presented to our pediatric outpatient clinic with gradually increasing holocranial headache, blurring of vision, sweating, photophobia, progressive quietness in nature and poor performance in school, increased thirst and urine output for one week along with pain over bilateral lower limbs and difficulty walking without support for 20days. Parents also reported two episodes of generalized convulsions with one episode of opisthotonic posturing and up rolling of eyes, which was sustained for 50 min. Family history of three sudden deaths, and father, a known case of pheochromocytoma along with clinical presentation, raised the suspicion of familial pheochromocytoma. Conclusion: Though pheochromocytomas are rare tumours, a high level of suspicion in paediatric age group, where patients don't present with classical symptoms, leads to early diagnosis and management and prevents catastrophic events. Young patients with bilateral disease and positive family history should be offered genetic testing. Preoperative catecholamine blockade and meticulous anaesthetic and surgical management are the keys to successful perioperative management of bilateral pheochromocytoma.