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Meningoencephalocele is herniation of cerebrospinal fluid, brain tissue and meninges through the skull defect. The anaesthetic management of occipital meningoencephalocele is challenging because of the difficulty in securing airway, prone position, blood loss and, perioperative care. The two major aims of the anaesthesiologists while caring for children with occipital encephalocoele intraoperatively are to avoid premature rupture of the encephalocoele and to manage a possible difficult airway due to restricted neck movement and inability to achieve optimal position for intubation of the trachea. We report a case of giant occipital meningoencephalocele presented for surgical excision. Perioperative management of patients with giant meningoencephalocele may be challenging for both anaesthesiologist and neurosurgeon. These patients must be managed closely with an interdisciplinary approach.

BACKGROUND: Laryngeal Mask Airway (LMA) is a supraglottic airway device, requiring optimal conditions for insertion to minimize the hemodynamic perturbation associated with LMA insertion. The aim of our study is to compare Dexmedetomidine-Propofol (Dp) and Fentanyl-Propofol (Fp) for conditions of LMA insertion in short surgeries under general anesthesia. AIMS AND OBJECTIVES: To compare efficacy of Dexmedetomidine-Propofol and Fentanyl-Propofol for LMA insertion in terms of 1) Ease of insertion, 2) The Hemodynamic responses to LMA insertion. MATERIALS AND METHODS: Ours was a double blinded randomized comparative study having 30 patients in each group, Dp and Fp, where patients received 1µg/kg of dexmedetomidine and fentanyl respectively followed by Propofol 2.5mg/kg as per protocol. The ease of LMA insertion parameters (Jaw relaxation, Coughing or movement during insertion, number of attempts required) and hemodynamic parameters (Mean heart rate, mean Systolic BP, mean Diastolic BP, Respiratory rate, SPO2) were monitored at following time intervals: Baseline, Pre-med, Pre LMA, Post LMA (at insertion), 1 min, 2 mins, 3 mins, 5 mins, 7 mins, 10 mins. Statistical analysis: Statistical analysis was done by using descriptive and inferential statistics using Chi square test, Wilcoxon signed rank test and Mann Whitney U test. The software used in the analysis was SPSS 17.0 version and Graph Pad Prism 5.0 and p< 0.05 is considered as level of significance. RESULTS: Jaw relaxation was statistically better, with less incidence of coughing in dexmedetomidine group. Hemodynamic parameters remained stable in Dexmedetomidine group whereas in fentanyl group a rise in HR and SBP was seen Post LMA insertion which stabilized quickly. Numbers of attempts of LMA insertion were comparable, with SPO2 and ETCO2 values within normal limits. CONCLUSION: Dexmedetomidine gives better insertion conditions and better attenuation of pressor response to LMA insertion compared to fentanyl in the given doses.

Background: Levobupivacaine has been purported to be as efficacious as Bupivacaine for epidural anaesthesia in recent literature.Methods: With the intent to study the same in caesarean section cases in our set up, we observed various intra- and post-operative variables in two groups (Levobupivacaine and Bupivacaine) of 60 healthy parturients. Sixty parturients for elective caesarean section were allocated randomly to receive epidural block with 10-20 ml of either 0.5% Levobupivacaine with Fentanyl 25µg or 0.5% Bupivacaine with Fentanyl 25µg to reach T6 level.Results: Mean total volume in Bupivacaine group was 15.23ml and in Levobupivacaine group was 12.76 ml. The difference was statistically significant. There was significant difference between the groups in the sensory block. The onset of analgesia was earlier in Levobupivacaine group. Mean time was 6.20 minutes in Bupivacaine group and 4.36 minutes in Levobupivacaine group. The duration of motor block was significantly short in Levobupivacaine group. Mean Time for recovery from motor block in Bupivacaine group was 2.5 hours and in Levobupivacaine group 1.5 hours. Mean time to achieve T6 height was earlier in Levobupivacaine group i.e. 16.46 minutes in Bupivacaine group and 13.26 minutes in Levobupivacaine group. Duration of postoperative analgesia was similar. There was no significant difference in neonatal outcome.Conclusions: Levobupivacaine was found to fare better than Bupivacaine in the studied intra and post-operative parameters and is hence recommended over racemic Bupivacaine for epidural block in patients undergoing elective cesarean section.