Background: Ludwig’s angina (LA) is a life-threatening condition, in which there is gangrenous cellulitis of floor of mouth that spreads through facial planes to involve neck region and has the potential to cause airway obstruction. Even though with advent of broad-spectrum antibiotics, it’s incidence has decreased considerably, the anesthetic management of patients, particularly children, undergoing drainage for LA group STILL remains a challenging task. Aims and Objectives: The aim of this study was to test the efficacy and safety of intravenous combination of dexmedetomidine and ketamine (DEXKET) for the drainage of abscess in patients having LA. Materials and Methods: This was a prospective study, in which 40 cases having LA and posted for Abscess drainage were included on the basis of a redefined inclusion and exclusion criteria. Abscess drainage was done under anesthesia using DEXKET as the only intravenous drug. DEXKET was prepared by mixing dexmedetomidine 0.5 mcg/kg along with ketamine 1 mg/kg in a 5 ml syringe and then diluted until 5 ml with distilled water. This was given as bolus dose. Drainage was accomplished under IV (DEXKET) sedation. Results: In this study, there were 28 males and 12 females with a M: F ratio of 1:0.42. The mean age of male and female patients was found to be 38.35±10.58 and 36.41±11.37 years, respectively. Dental caries was the most common cause leading to LA which was seen in 32 (80%) patients. There were no episodes of significant bradycardia, hypotension or desaturation during surgical procedure, as well as in post-operative period. The procedure could be accomplished without any additional doses of DEXKET. Two of the patients (5%) had post-operative nausea and vomiting. Conclusion: Drainage under sedation by intravenous combination of DEXKET is found to be an effective approach for drainage of abscess in cases of LA.

Objectives: The aim of the study was to find out the efficacy of thoracic segmental spinal anesthesia combined with unilateral erector spinae block in patients undergoing unilateral modified radical mastectomy and axillary lymph node dissection Methods: This was a prospective cohort study in which 40 patients with carcinoma breast undergoing modified radical mastectomy with axillary dissection under thoracic segmental spinal anesthesia combined with unilateral erector spinae block were included on the basis of a predefined inclusion and exclusion criteria. Erector spinae plane block was given at T5 level and thoracic spinal anesthesia was then given at T5–T6 level in the same position by median or paramedian technique. Patients were assessed for severity of pain by visual analog scale score till 24 h of surgery. Results: The mean age of studied cases was found to be 44.12±10.04 years. Mean weight of studied cases was 54.38±9.8 kg, whereas mean duration of surgery was found to be 98.24±16.86 min. The most common American Society of Anesthesiologists (ASA) grade to which patients belonged was found to be ASA III (55%) followed by ASA II (30%) and ASA I (15%). Eleven patients required rescue analgesia within first 24 h after surgery and mean doses of rescue analgesia in 1st 24 h after surgery was found to be 0.92±0.48. Four (10%) patients developed hypotension, whereas three (7.5%) patients had bradycardia. However, all these 7 (17.5%) had transient bradycardia or hypotension which could be managed by IV Atropine or IV mephentermine and fluid bolus. Conclusion: Thoracic segmental spinal anesthesia combined with unilateral erector spinae block is an excellent option for patients undergoing modified radical mastectomy with axillary dissection.

Neurofibromatosis is a multisystem disorder with a relentless course. It poses a particular challenge to the anesthesiologist due to involvement of airway, spine, central and peripheral nervous system with systemic neurohormonal implications that can all lead to an adverse intraoperative course. Hence an understanding and detailed evaluation of systemic and local involvement of NF-1 is essential. Pregnancy has additional implications in a patient of NF-1, with an increase in size of neurofibromas, IUGR, preterm labour, hypertension secondary to pheochromocytoma, to name a few. We present the case of a 38 weeks pregnant 29-year-old female with NF-1 who underwent LSCS under spinal anesthesia and had an uneventful recovery. Our aim is to understand the anesthesia implications of NF-1 and present our unusual case.