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Meningoencephalocele is herniation of cerebrospinal fluid, brain tissue and meninges through the skull defect. The anaesthetic management of occipital meningoencephalocele is challenging because of the difficulty in securing airway, prone position, blood loss and, perioperative care. The two major aims of the anaesthesiologists while caring for children with occipital encephalocoele intraoperatively are to avoid premature rupture of the encephalocoele and to manage a possible difficult airway due to restricted neck movement and inability to achieve optimal position for intubation of the trachea. We report a case of giant occipital meningoencephalocele presented for surgical excision. Perioperative management of patients with giant meningoencephalocele may be challenging for both anaesthesiologist and neurosurgeon. These patients must be managed closely with an interdisciplinary approach.

A 26 year female diagnosed to have spinal cord tumor was posted for laminectomy and excision of tumor. She had complaints of progressively increasing pain and weakness in lower back and both lower limbs since ABSTRACT Sinus tachycardia in a patient undergoing surgery under general anaesthesia is not an uncommon experience in anaesthesia practice. Causes of intraoperative sinus tachycardia can be multi-factorial. Operative causes are pain, surgical stimulation and light depth of anaesthesia. Pharmacological factors include administration of catecholamines, atropine, or ketamine. Medical factors such as sepsis, hypovolaemia, heart failure, anaemia, and thyrotoxicosis should also be considered. We report a case of inadequately controlled hyperthyroidism undergoing surgery for a spinal cord tumour under general anaesthesia who developed unexplained tachycardia intraoperatively.

Calcium plays a major role in a number of physiological actions. Primary hyperparathyroidism is the most common cause of hypercalcaemia. Many patients with primary hyperparathyroidism are asymptomatic. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. We present the successful anaesthetic management of a patient with primary hyperparathyroidism and discuss the anaesthetic issues involved.