In high-risk patients with significant cardiovascular and other systemic disorders, administration of central neuraxial block or general anaesthesia is usually associated with adverse haemodynamic effects and high perioperative mortality. This case report is about a 57-year-old male patient with known case of Diabetes Mellitus (DM) posted for lower limb debridement. He had comorbidities like cellulitis, sepsis, uncontrolled diabetes, multiorgan dysfunction and was haemodynamically unstable. Peripheral nerve blockade keeps the haemodynamic more stable as compared to central neuraxial blockade and general anaesthesia. Therefore, popliteal nerve block was given to the patient in prone position. Peripheral nerve locator was used and after eliciting the response of foot twitch local anaesthetic drug was deposited. Adequate sensory motor block was achieved and surgery was carried out uneventfully. Patient was vitally stable throughout the surgery. Thus, it was seen that peripheral nerve blocks are an effective alternative to central neuraxial blockade and general anaesthesia in high risk patients undergoing below knee surgeries.

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Myasthenia gravis is a chronic autoimmune disease of neuromuscular junction which causes skeletal muscle weakness and fatigability, characterised by decrement in postsynaptic acetylcholine receptor at neuromuscular junction caused by auto-antibodies destruction. There are three types of myasthenia gravis in children- transient neonatal, congenital and juvenile. Juvenile Myasthenia Gravis (JMG) is an autoimmune disorder that can affect the all skeletal muscles including extraocular muscles, which may lead to fatigability and generalised weakness. This report is about a case of seven-year-old patient weighing 25 kg presented with throat pain since one and half month. Patient was a known case of congenital myasthenia gravis and diagnosis was confirmed by Edrophonium test. He underwent tonsillectomy and was successfully managed under general anaesthesia with no muscle relaxant technique. Tonsillectomy in paediatric patients is not an uncommon surgical procedure. In spite of being a common surgery, it is still challenging to the surgeon as well as the anaesthesiologist as there is a shared airway between the two. Also, in the postoperative period there are chances of post-tonsillectomy bleeding causing airway obstruction, if not diagnosed and treated early could risk the life of the patient. Therefore, this surgery poses an increased risk of mortality and morbidity.

Background: The study aimed to compare and determine the success rate, ease of introducing I-gel and the hemodynamic effects of two adjuvant drugs ketamine and fentanyl, when used with induction agent propofol in minor surgical procedures.Methodology: The study comprised of 68 patients of ASA-I & II grading of either gender, aged between 18 to 60 years undergoing minor surgical procedures. Patients were distributed into two groups.Group K- inj. ketamine 0.5mg/kg & inj. propofol 2mg/kgGroup F- inj. fentanyl 1mcg/kg & inj. propofol 2mg/kgResults: Both groups K and F were comparable in terms of baseline clinic-sociodemographic variables such as age, gender, weight, ASA grade and Mallampatti grade. Attempt of insertion was more than one in 26.5% cases of group K and 8.8% cases of group F, showing statistically insignificant difference(p>0.05). Jaw relaxation was significantly good in group F than group K (p<0.01). Incidence as well as severity of coughing and limb movement was much higher in group K than group F (p<0.01). Overall excellent significantly higher condition was observed. Excellent conditions seen in 85.3% and 50% cases belonging to group F and group K respectively (p<0.01). Mean total requirement of propofol was 124±24.56 and 110.06±18.95 in cases belonging to groups K and group F respectively. Thus showing significant difference. Hemodynamic parameters such as heart rate(HR) and blood pressure(BP) were significantly higher in group K than in group F following induction(p<0.01).Conclusion: Fentanyl when used as co-induction drug with propofol provides ideal condition for I-gel insertion, decreases total requirement of propofol & stable hemodynamic response as compared to ketamine & propofol