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Intra cranial aneurysms are acquired lesions responsible for about 80% of non-traumatic sub arachnoid hemorrhage. Treatment of the condition in the past has relied on craniotomy and clipping of the aneurysm to prevent a recurrent hemorrhage. Nowadays endovascular coiling is the best primary treatment. The anesthesia in interventional radiology room has special arrangement and precautions. Intra operative management of endovascular cerebral aneurysm from the start including: arrangement of the room, monitoring, induction, maintenance and emergence of the patients. Post-operative care is very important and good management of potential perioperative complications like: aneurysm rupture, cerebral infarction, cerebral vasospasm, contrast reaction and nephropathy is mandatory. Aim of the Study: reviewing the current medical literature as regards the anesthetic considerations and problems of endo-vascular management of intracranial aneurysm. Conclusion: anesthesia in interventional radiology room should have special arrangements and precautions. Intra operative management of endovascular cerebral aneurysm from the start including: arrangement of the room, monitoring, induction, maintenance and emergence of the patients. Post-operative care plays a key role in mitigating potential perioperative complications like: aneurysm rupture, cerebral infarction, cerebral vasospasm, contrast reaction and nephropathy are mandatory.

Background The aim of this study was to compare the efficacy of ultrasound-guided adductor canal block versus femoral nerve block in postoperative analgesia, as well as their effect on quadriceps muscle strength. Results The study included 66 patients who were underwent arthroscopic anterior cruciate ligament reconstruction under general anesthesia. They were randomly divided into 2 groups; A and F, of 33 patients in each. Patients in group A received an adductor canal block, while patients in group F received a femoral nerve block. The primary outcome was the total morphine requirements in the first 24 h after the procedure. Secondary outcomes included time to first analgesic request and the patients’ ability to perform straight leg raise in the post-anesthesia care unit and 2 h later. The straight leg raise was impaired in group F compared with group A both in the post-anesthesia care unit (p value = 0.017) and 2 h postoperatively (p value = 0.020). While there was no differences between both groups regarding time to first analgesic request, and total morphine requirements. Conclusions Compared with femoral nerve block, the adductor canal block may be an effective analgesic alternative with the advantage of sparing the quadriceps muscle strength in anterior cruciate ligament reconstruction surgeries.

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Background Early tracheal extubation of recipients following liver transplantation (LT) has been promoted and gradually replacing standard postoperative prolonged mechanical ventilation, possibly contributing to better graft and patient survival and reduced costs. There are no universally accepted predictors of success of immediate extubation in LT recipients. We hypothesized a number of factors as predictors of successful immediate tracheal extubation in living donor liver transplantation (LDLT) recipients. Aim The aim of this study was to evaluate the validity of the following hypothesized factors: Model for end stage liver disease (MELD) score, duration of surgery, number of intraoperatively transfused packed red blood cells (RBCs) units and end of surgery (EOS) serum lactate, as predictors of success of immediate tracheal extubation in living donor liver transplantation (LDLT) recipients. Methods In this prospective clinical trial, perioperative data of adult LDLT recipients were recorded. “Immediate extubation” was defined as tracheal extubation immediately and up to 1 hour postransplant in the operating room. Patients were divided into; extubated group who were successfully extubated with no need for reintubation, and non-extubated group who failed to meet criteria of extubation or were re-intubated within 4 hours of extubation. Results Of 64 patients, 50 (76.9%) were extubated early after LDLT while 14 (23.07%) were transported to the intensive care unit (ICU) intubated. After data analysis, it was found that EOS serum lactate, duration of surgery and number of packed RBCs units transfused intraoperatively, were good predictors of success of immediate extubation, while MELD scores had no statistically significant impact on the results. In addition, other factors such as EOS urine output and pH were shown to have significantly affected the results. Conclusions EOS serum lactate, duration of surgery and number of packed RBCs units transfused were predictors of post-transplant early extubation.