A 14-year-old autistic boy presented with acute gastroenteritis and hypotension. The electrocardiogram showed a ventricular fibrillation rhythm – he went into cardiorespiratory arrest and was immediately resuscitated. On investigation, the electrocardiogram showed a partial right bundle branch block with a “coved” pattern of ST elevation in leads v1–v3. A provisional diagnosis of Brugada syndrome was made, for which an automated implantable cardioverter defibrillator (AICD) implantation was advised. Although the automated implantable cardioverter defibrillator implantation is usually performed under sedation, because this was an autistic child, he needed general anaesthesia. We performed the procedure uneventfully under general anaesthesia and he was discharged after a short hospital stay.

Neurosurgery in the sitting position is used for resection of tumors located in the cerebellopontine angle, pineal region, other technically difficult tumors in the infratentorial region, as well as surgeries of the cervical spine. Since its inception, the use of this particular position has been contentious due its risk-benefit analysis. With improved microsurgical equipment and surgical and anesthetic techniques, as well as advanced monitoring techniques to assure patient safety, many centers are revisiting the sitting position for its potential benefits. Abstract Keywords ► patent foramen ovale ► sitting position ► venous air embolismTo ensure patient safety and a successful outcome, a thorough preoperative anesthetic evaluation to decide if the sitting position is suitable for the patient is essential. As in any neurosurgical case, all patients need to be evaluated preoperatively for physical and neurological status, as well J Neuroanaesthesiol Crit

Fluid therapy in neurosurgical patients aims to restore intravascular volume, optimise haemodynamic parameters and maintain tissue perfusion, integrity and function. The goal is to minimise the risk of inadequate cerebral perfusion pressure and to maintain good neurosurgical conditions. However, fluid management in brain-injured patients has several distinctive features compared with non-brain-injured critically ill patients. The ROSE concept advocates the restriction of fluids, which is consistent with the prevention of a ‘tight brain’ in neurosurgery. Whether this imbalance in fluid management studies between different types of brain injuries is a reflection of differences in clinical relevance of fluid management is not clear. Further randomised controlled trials in the future are essential in subarachnoid haemorrhage and traumatic brain injury patients who are critical and need long-term Intensive Care Unit stay to elucidate and define the role and relevance of the ROSE concept in neuroanaesthesia and neurocritical care.

Cerebral aneurysms can be complex and variable in size, position, and morphology, resulting in difficult surgical exposure and secure clip placement. They have a high mortality rate when ruptured, and though endovascular techniques have emerged to tackle this, surgical clip ligation remains the preferred modality for some aneurysms. Various techniques that help the surgeon dissect the aneurysmal dome and apply the clip are temporary clip ligation of proximal vessels, deep hypothermic circulatory arrest, and balloon suction decompression. All of them require significant logistics and result in increased morbidity and mortality. Adenosine is a suitable alternative for inducing a temporary flow arrest, causing a short period of controlled hypotension. Its rapid onset and offset property along with low incidence of adverse events makes it an ideal agent in this regard. We present here a review on its use, contraindications, safety profile, and future applications.

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