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Background: Generalized seizures have been reported following epidural anesthesia but rarely after spinal anesthesia. Aim and objective: The aim and objective of our study is to create awareness about a rare possibility of bupivacaine-induced generalized tonic-clonic seizures. Case description: A 19-year-old primigravida with no history of any medical disease had episodes of generalized tonic-clonic seizures following spinal anesthesia. The patient lost consciousness and was immediately intubated after two episodes of seizures. Later on, she was shifted to the intensive care unit for mechanical ventilation. Conclusion:Although convulsions following spinal anesthesia are rare, parturients can develop complications such as generalized tonicclonic seizures, respiratory depression, and loss of consciousness following spinal anesthesia. These patients require stringent and meticulous monitoring in perioperative period as those for general anesthesia.

Context:Perioperative fluid management in elderly poses considerable challenge to the anesthesiologist. The conventional crystalloid loading may not be a preferred regime in this subgroup of patients since an exaggerated hemodynamic response is expected due to blunted sympathetic response and compromised cardiorespiratory system.Aims:This study was designed in the elderly patient for comparing efficacy, side-effects and limitations of prophylactic ephedrine 30 mg (intramuscular [i.m.]) versus polygeline 3.5% 500 ml (intravenous [i.v.]) for the maintenance of blood pressure after subarachnoid block (SAB).Settings and Design:The sample size of 100 elderly (age > 50 years) patients undergoing orthopedic surgeries was administered SAB using bupivacaine 0.5% heavy. The primary outcome of this study was the attenuation of hypotension due to SAB using ephedrine or polygeline 3.5%.Materials and Methods:A total of 100 patients were randomly allocated to receive ephedrine 30 mg i.m. 10 min before the institution of SAB in Group I and preloading with 500 ml of polygeline 3.5% i.v. over 10 min prior to SAB in Group II. Patients in both groups were closely monitored for pulse rate, systolic blood pressure; any hypotension, requirement of rescue therapy and adverse effects.Statistical Analysis Used:Results were interpreted using Student's t-test for parametric and Chi-square tests for nonparametric data.Results:The incidence of hypotension and requirement for rescue therapy was statistically less in Group I compared with Group II (P < 0.05). Heart rates were better maintained in Group I than Group II, with few hemodynamic adverse effects in both groups.Conclusions:Ephedrine 30 mg i.m. given as pretreatment before SAB in elderly patients was more effective for the prevention of post-SAB hypotension.

Introduction:Premedication with sedative drugs is often used in paediatric practice as one of the modalities to reduce preoperative anxiety in children undergoing surgery. It reduces both patient and parental anxiety and improves overall satisfaction. Also, provides anterograde amnesia and reduces postoperative behavioral changes and adverse outcomes in children. The ideal premedication in children should be readily acceptable and should have speedy and reliable onset with negligible side effects. Materials and Methods: After obtaining institutional medical ethics committee approval, sixty ASA physical status I or II children, aged 1-8 years scheduled for elective surgery were randomly allocated into one of the two groups. Group M (n=30): received preservative free oral midazolam 0.5mg/kg (1ml=5mg) + acetaminophen based syrup (5ml=120mg) upto maximum value of 0.4ml/kg. Group MK (n=30): received preservative free oral midazolam 0.25 mg/kg (1ml=5mg)with 3mg/kg oral ketamine(1ml=50mg) + acetaminophen based syrup (5ml=120mg) upto maximum value of 0.4ml/kg. Results: Combination of midazolam0.25mg/kg and ketamine3mg/kg provided faster onset and higher degree of sedation, comparable incidence of satisfactory parental separation and mask acceptance without any added side effects in comparison to midazolam 0.5mg/kg. Conclusion: Addition of low dose ketamine to midazolam as a premedication provides adequate sedation.

Local anesthetics are one of the most commonly used drugs in the field of medicine. Local anesthetics are widely used to induce anesthesia and analgesia for surgical procedures and pain management. Local an aesthetic systemic toxicity (LAST) is a rare but potentially fatal complication of regional anesthesia and has been recognized and reported since the late1800s. This narrative review summarizes the pharmacology of local anesthetics, clinical manifestations of systemic toxicity associated with these agents, necessary preventive measures and recent treatment strategies.