Aneurysmal subarachnoid hemorrhage (SAH) is a devastating neurological syndrome, which occurs at a rate of 3-25 per 100,000 population. Smoking and hypertension are the most important risk factors of subarachnoid hemorrhage. Rupture of cerebral aneurysm leads to rapid spread of blood into cerebrospinal fluid and subsequently leads to sudden increase of intracranial pressure and severe headache. Subarachnoid hemorrhage is associated with neurological (such as re-bleeding and vasospasm) and systemic (such as myocardial injury and hyponatremia) complications that are causes of high mortality and morbidity. Although patients with poor-grade subarachnoid hemorrhage are at higher risk of neurological and systemic complications, the early and aggressive management of this group of patient has decreased overall mortality by 17% in last 40 years. Early aneurysm repair, close monitoring in dedicated neurological intensive care unit, prevention, and aggressive management of medical and neurological complications are the most important strategies to improve outcome.

Pneumocephalus is air in the cranium commonly seen in postcraniotomy and in head injury patients. When this air causes an increase in intracranial pressure leading to neurological deterioration, it is called tension pneumocephalus. Similarly, intraventricular air causing compression on vital centers and increasing intracranial pressure is called tension pneumoventricle, and this causes expressive aphasia, which is rarely described in the literature. This study reported a case of a traumatic cerebrospinal fluid (CSF) leak leading to tension pneumoventricle and aphasia. Case: A young male patient sustained severe head injury and had extradural hematoma (EDH) and multiple skull and skull base fractures. EDH was drained, and he recovered and was discharged with a Glasgow coma scale score of 15. He presented to neurosurgical outpatient with CSF leak, aphasia, and loss of bowel and bladder control for a duration of three days. Computed tomography brain scan showed tension pneumoventricles, and he was started on conservative management. His general condition deteriorated, and the next day, his pupils became unequal, and Glasgow coma scale (GCS) dropped to 8/15. He was immediately taken to theater, and the air was aspirated from the ventricles, and an external ventricular drain was inserted. The patient woke up in the immediate postoperative period and started talking normally by day four. Conclusion: Tension pneumoventricles should be considered a cause of aphasia. Immediate intervention and reduction of intracranial pressure are crucial to reverse neurological abnormality and improve patient's outcome.

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Acute mesenteric ischemia (AMI) is a rare surgical emergency as it involves perfusion and need frequent surgical interventions. It is a life threatening emergency with a poor prognosis. It is classified according to the etiological basis thromboembolism, non-obstructive and venous origin. AMI has various risk factors ranging from cardiac arrhythmias to the intraabdominal hypertension. Apart from the signs and symptoms, the multi-detector computer tomography remains a diagnostic tool with accuracy. In the management of AMI patients' initial resuscitation, hydration and analgesia play important role, however the operative /interventional management is either endovascular thrombectomy with or without stenting when there is no bowel involvement or peritonitis. The laparotomy with open vascular thrombectomy with vascular graft, it is indicated when bowel involvement and peritonitis patients. Often the whole bowel is gangrenous and no further treatment is needed because of certain mortality. The 2 nd step is to know the extent of bowel involvement meticulously and resection of bowel with necrosis or gangrene with anastomosis, further relook laparotomies and resection of the bowel may be need. Initially abdomen will be closed with Bagota bag or VAC (Vacuum Assisted Closed) dressing and final staged abdominal closer, once pathology resolves completely. As far as prevention of all types

This topic aims to discuss key aspects of anesthetic and airway management for head and neck surgery. Airway management is a central part of patient care and management in Head and Neck Surgery. Common challenges in Head and Neck surgery are shared airway, distorted airway anatomy due to existing pathology; risk of airway obstruction, disconnection or loss of airway intra-operatively; risk of soiling of the airway due to bleeding and surgical debris; and the potential for airway compromise post-operatively. The option for airway management technique is influenced by patient’s factors, anesthetic needs, and surgical requirements. Intubation technique necessitating either a small or large cuffed tracheal tube with a throat pack provides the highest level of airway protection Non-intubation or open airway techniques involve mask ventilation, apneic techniques, and insufflation techniques, or the use of a laryngeal mask airway. Lastly, jet ventilation techniques may be conducted via a supraglottic, subglottic or transtracheal routes. It is essential to have clear airway management plans including rescue airway strategies that should be communicated with the surgeons and patients at the earliest opportunity.