Classic hemophilia or hemophilia A is a congenital bleeding diathesis in which the affected individual may present with spontaneous hemorrhage or persistent bleeding even after minor trauma. Knowledge about the disease process, multidisciplinary team approach, and timely management can lead to favorable outcome in these patients. We report management of a child with hemophilia A for suturing of lacerated upper lip mucosa following trauma. A review of literature with recommendations for perioperative management, especially in the setting of emergency surgery, is also provided.

Background-Ketamine induced hemodynamic pressor response should be attenuated by appropriate premedication. The present study was designed to evaluate and compare the efficacy of dexmedetomidine and clonidine premedication to counter the effects of ketamine.Method-A total of 68 normotensive adult female patients of ASA grade I and II, aged 20-50 years, weighing between 40-65 kgs and undergoing dilatation and curettage under ketamine anaesthesia were randomized for this double blind, interventional, hospital based study.These patients were divided into two treatment groups of 34 patients each. Group A (n=34) received Clonidine 1mcg/kg as continuous i.v. infusion over 30 minutes before induction. Group B (n=34) received Dexmedetomidine 1mcg/kg as continuous i.v. infusion over 10 minutes before induction Observations regarding the demographic profile, preoperative and intraoperative heart rate, mean arterial pressure were recorded. Analysis of data was done using unpaired student "t" test and chisquare tests.A "p" value <0.05 was considered significant.Result: No statistically significant difference was found in age, weight & ASA grade of both groups (p>0.05). Mean heart rate in Group A was 81.91± 6.84 and in Group B 80.94±7.09 (P value = 0.56 no statistical significance); after induction with ketamine,HR in Group A was 102.35± 12.55 and in Group B 78.02± 9.91 (P value = 0.000 high statistical significance). Mean arterial pressure in Group A was 90.85± 5.86 and in Group B 93.43± 8.14 (P value = 0.13 no statistical significance); after induction with ketamine, MAP in Group A was 103.76±7.74 and in Group B 99.05± 11 (P value = 0.04 statistical significance). Conclusion: Dexmedetomidine attenuates ketamine induced hemodynamic pressor response more effectively than clonidine. It maintains stable hemodynamic parameters during dilatation & curettage under ketamine anaesthesia.