Background: Fascia iliaca compartment block (FICB) following femoral fracture surgery provides effective analgesia. Reports of morphine added to ropivacaine for peripheral nerve blocks are limited. We designed this study to investigate the effects of morphine as an adjuvant to ropivacaine in FICB for femoral fracture surgery. Methods: Seventy patients undergoing spinal anaesthesia for femoral fracture surgery were randomized to undergo ultrasound aided FICB with ropivacaine alone (n = 35) or in combination with morphine (n = 35). FICB was performed postoperatively with 20 ml of 0.375% ropivacaine plus 2 ml normal saline or 20 ml of 0.375% ropivacaine plus 2 ml (1 mg/ ml) morphine. Primary outcome parameter was the duration of analgesia. Secondary outcome parameters were total doses of rescue analgesics, sedation scores, Numeric Rating Scale (NRS) scores for pain and patient satisfaction. Results: Demographic data were similar between the two groups. Patients receiving morphine adjuvant had longer duration of postoperative analgesia (541 ± 167 vs 634 ± 164 mins, p = 0.01; Mean difference -92.71; 95% CI: -171.95 – -13.47). Requirement of postoperative rescue analgesics for the first 24h was significantly lesser (tramadol 77 ± 25 vs 62 ± 22 mg, p = 0.01; Mean difference 14.28 ;95% CI: 2.95 – 25.63) in patients receiving morphine adjuvant. Postoperative NRS scores and sedation scores were comparable between the two groups. Conclusion: Morphine as an adjuvant to ropivacaine for FICB significantly prolongs the duration of postoperative analgesia.

Rationale: Pediatric lung isolation is a great challenge to an anesthesiologist. Despite various advances in techniques and equipment in lung isolation, most of the sophisticated devices are unavailable in remote setups. Blind techniques have been used, but they have a low success rate. Patient concerns: Here we report a case of a five year old male child who had cough and fever for one month. CT scan of chest revealed right sided empyema thoracis for which decortication was planned under general anaesthesia with one lung ventilation. Double lumen tube for this patient was not commercially available and we did not have a paediatric fiberoptic bronchoscope, which would fit inside the endotracheal tube necessary for the patient. Interventions: After anesthesia induction, an adult fiberoptic bronchoscope was used as an aid for insertion of bougie into the left mainstem bronchus followed by rail roading the endotracheal tube over the bougie for lung isolation. Outcomes: Surgery then proceeded in left lateral position with a right thoracotomy under a quiet surgical field. Conclusion: In case of unavailability of paediatric fiberoptic bronchoscope, an adult fiberoptic bronchoscope and a bougie can aid in successful lung isolation in paediatric patients.

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Background Respiratory adverse events are not uncommon in the post-anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15-year-old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation The 15-year-old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 min in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally, she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol. Conclusion Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such cases in the PACU.

Background: Respiratory adverse events are not uncommon in the post-anesthesia care unit (PACU) following general anesthesia. In this regard, hyperventilation leading to apnea and desaturation is a rare entity. Here we have reported a case of a 15-year-old girl who, following an uneventful general anesthesia, developed severe hyperventilation leading to apnea and desaturation in the PACU. Case presentation: The 15-year-old girl underwent cortical mastoidectomy under general anesthesia. After a smooth anesthesia and an uneventful early recovery, she developed hyperventilation after about 15 minutes in the PACU. The symptom was severe enough to lead to apnea, desaturation and severe respiratory alkalosis. She required bag and mask ventilation and the symptoms resolved only transiently with propofol sedation. Finally, she responded to intravenous haloperidol and did not have any further episode after receiving haloperidol. Conclusion: Hyperventilation after a smooth recovery from anesthesia is not a common presentation. In this article we have tried to discuss the possible cause of such symptom in our patient and how we successfully managed this case. We have also proposed an algorithmic approach to diagnose and manage such cases in the PACU.