Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. The survival of patients with uncorrected TOF till the fourth decade of life is rare (around 3%). Pregnancy in a patient with uncorrected TOF requires a multidisciplinary approach. A confluence of pregnancy, uncorrected TOF and shock is infrequent. The state of hypovolaemia and a decrease in systemic vascular resistance due to anaesthetic agents increase the right to left shunt. The decrease in pulmonary blood flow provokes a ‘hypercyanotic spell’. We report the successful management of 30-year-old pregnant (G3P2A2L0) with uncorrected TOF, presenting to the emergency department with incomplete abortion in shock.

Diencephalic syndrome is one of the rare causes of failure to thrive in infants and young children. It is caused by a tumour in diencephalon (thalamus and hypothalamus), characterised by profound emaciation with uniform loss of body weight despite normal or slightly decreased appetite, locomotor hyperactivity, euphoria and visual symptoms. Anaesthetic considerations due to decreased body fat include positioning to avoid pressure necrosis, measures to avoid hypothermia, proper drug dosing, treating electrolyte imbalances and delayed recovery. We report successful anaesthetic management of a child with diencephalic syndrome scheduled for an endoscopic biopsy of suprasellar space occupying lesion under general anaesthesia.