aneurysm. The patient did not suffer any cardiological and neurological insufficiency; haemodynamics remained stable and was tracheally extubated after planned elective overnight post-operative mechanical ventilation. We repeated electrocardiograms (ECGs), echocardiograms and Troponin I assay post-operatively at 6 and 24 h, respectively, which were within normal limits.A 44-year-old female with interstitial lung disease and Systemic Lupus Erythematosus presented with subarachnoid haemorrhage (Hunt and Hess Grade I, WFNS Grade-I) and investigations revealed a large fusi-saccular left vertebral artery aneurysm. We planned treatment by clip reconstruction and anticipated the use of adenosine to facilitate dissection and deal with a possible intra-operative rupture. We followed all necessary precautions like putting the external defibrillator paddles and keeping defibrillator ready with closed monitoring of vitals. During dissection, the aneurysm ruptured. At the time of rupture, the arterial blood pressure was 100/60 mmHg with heart rate of 60 beats/min. Adenosine 18 mg IV was administered as a quick bolus through the central line with 20 ml of normal saline flush. Asystole was achieved for 25 s, during which, the surgeon could clip the ruptured part of the aneurysm. Following asystole, the patient's heart rate recovered spontaneously without any haemodynamic sequelae. The surgeons again requested for a second dose for further clip reconstruction of the fusiform aneurysm. By this time, the patient had suffered a blood loss of about 1.5 l and patient's arterial blood pressure was 96/60 mmHg and heart rate of 70 beats/min with normal sinus rhythm. The second dose of adenosine (18 mg) was administered after about 22 min from the first dose, following which asystole was achieved in 15 s, which lasted for further of 20 s. The patient developed supraventricular tachycardia (SVT) on recovery from asystole with mean arterial pressure of 50 mmHg, which soon progressed to atrial fibrillation (AF) with persistent hypotension; this helped the surgeons to apply permanent clip. Following surgery, AFs continued and so, we decided to deliver synchronised DC shock with 100 J. This led to immediate return of sinus rhythm with arterial blood pressure of 90/60 mmHg and heart rate of 88 beats/min with minor T-wave changes, which recovered fully after about 5 min. Rest of the surgery was uneventful. Volume resuscitation was done with colloids, crystalloids as well as packed red blood cells during the procedure and the patient was kept ventilated electively. Intra-operative and post-operative arterial blood gases

We report the case of a 46 year-old woman presenting with postoperative visual loss in the right eye after craniotomy for excision of an arteriovenous malformation. The intraoperative course was uneventful with hemodynamic stability and maintenance of blood pressure within 10% of the preoperative value. Blood loss was 300 ml; postoperative hemoglobin was 12.4 g/dl. In the recovery room, the ophthalmologic examination revealed decreased visual acuity, color vision, and visual field in the right eye. Assessment of the retina was normal, but the patient showed a relative afferent pupillary defect consistent with the clinical diagnosis of ischemic optic neuropathy. Anesthesiologists should be aware that this condition may follow uncomplicated intracranial surgeries in the supine position, and should obtain prompt ophthalmologic consultation when patients develop postoperative visual loss.

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