Acute respiratory distress syndrome (ARDS) is characterized by sudden onset of respiratory distress, infiltrates on radiographs consistent with pulmonary oedema, hypoxaemia and increased work in breathing. Infiltrates on radiographs are bilateral, but may be patchy or diffuse and fluffy or dense. It is associated with absence of left heart failure and a PaO2/FiO2 ratio of < or =200. Ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (DMSO), which was approved by the US FDA in July 2005, is used as an embolic agent for cerebral arteriovenous malformation (AVM). It is a biocompatible liquid polymer that precipitates and solidifies on contact with blood, thus forming a soft and spongy embolus. We report a case of ARDS following therapeutic embolization with ethylene vinyl alcohol copolymer for cerebral AVM under general anaesthesia. Experienced perioperative physicians adopted standard anaesthetic technique and monitoring for this procedure. Acute respiratory distress and hypoxaemia developed in the patient following extubation of the trachea. Infiltrates seen on postprocedural chest radiographs were consistent with pulmonary oedema. DMSO, the solvent for the ethylene vinyl alcohol copolymer, is excreted via the lungs after administration and we postulate that DMSO was the possible cause of ARDS in this patient. Monitoring of haemodynamic parameters (invasive blood pressure, electrocardiography) and ventilatory parameters (ETCO2, SpO2, airway pressure monitoring) are important in the recognition of this possible event. One should be vigilant and anticipate this complication following therapeutic embolization with ethylene vinyl alcohol polymer for the treatment of cerebral AVM.

Background: Respiratory distress in newborn is one of the commonest causes of neonatal mortality and morbidity in many developing countries. The early initiation of Bubble Continuous Positive Airway Pressure, a low-cost and simple technique can treat respiratory distress in an effective manner. We compared and studied the outcome of initiating bubble CPAP, by the 1 st hour of birth in neonates with respiratory distress. Bubble CPAP was a success amongst neonates who were of gestational age more than 32 weeks, weighing more than 1200gms and with Downes' score of less than 7. Methods: The study was conducted in a rural tertiary care hospital amongst 150 neonates admitted in intramural (in born) and extramural (out born) neonatal intensive care units. The study was done over a period 18 months. The primary outcome of the study was to compare the proportion of success or failure on early initiation of bubble CPAP. Results: In our study 94% of babies admitted with respiratory distress and started on Bubble CPAP survived while by early initiation in the 1 st hour, 80.9% of babies were treated successfully. Conclusion: Bubble CPAP has a high percentage of success when initiated early in neonates with mild and moderate respiratory distress