No abstract

We report a case of unusual presentation of transurethral resection of prostate (TURP) syndrome. A 58-year-old male patient with grade III benign hypertrophic hyperplasia was scheduled for TURP under spinal anesthesia. At 120 min of surgery, the patient presented with atypical symptoms of tightness in the chest with difficulty in breathing. The electrolyte analysis revealed an acute hyponatremia (serum Na+ 95 mEq/l). Patient was successfully treated with rapid infusion of 3% hypertonic saline along with furosemide.

A 32-year-old Indian female 38 weeks pregnant, with a history of multiple sclerosis since 2008 was admitted in obstetric ward for safe confinement. She had a history of diminution of vision in both eyes and limb weakness, relapsing – remitting type with movement-induced muscle spasms, in all the four limbs. Her symptoms were usually diplopia, difficulty in vision and ataxic gait. Sh was then treated with methylprednisolone. She was on oral dimethyl fumarate trial, which was stopped at the beginning of pregnancy. Presently, she was completely asymptomatic. Epidural anesthesia with an indwelling catheter was administered with 15 ml of 0.25% bupivacaine in 5 ml increments. A total of 3 mg of epidural morphine was given for post-operative analgesia. The surgery evolved without any intercurrences and patient was discharged from the hospital 72 h after surgery without worsening of her symptoms. We report a safe anesthetic management of a patient with MS undergoing cesarean section with low dose epidural bupivacaine with the addition of morphine for post-operative analgesia.

Managing airway in pediatric neurosurgical patients can prove to be challenging. In this article, we wish to touch upon the specific airway considerations to be kept in mind while caring for these patients during neurosurgeries.

Background Smooth and early emergence is always a concern in neurosurgical patients as it prevents complication and facilitates neurological examination and immediate postoperative intervention, if necessary. Methods A prospective randomized trial was conducted to evaluate the effects of propofol, sevoflurane, and desflurane used for maintenance of anesthesia at the time of emergence and recovery from anesthesia in 75 patients undergoing elective trans-sphenoidal surgery for pituitary tumors. We evaluated time for emergence and extubation, modified Short Orientation Memory Concentration Test (SOMCT) score, Aldrete's scores, pain score, and postoperative nausea and vomiting (PONV) score. Results Emergence and extubation times were significantly shorter in patients receiving desflurane as compared with those receiving propofol or sevoflurane (p < 0.001). Modified SOMCT and Aldrete's scores were comparable in all the three groups with better cognitive scores in patients who received desflurane. Heart rate and mean arterial pressure were comparable at emergence and extubation in all the three groups except mean airway pressure (MAP) at extubation that was higher in the desflurane group compared with propofol and sevoflurane groups (p = 0.02), which was clinically comparable. Pain and PONV scores were also comparable between the groups. Conclusions Desflurane had shorter time to emergence and time to extubation in comparison to propofol and sevoflurane. Thus, desflurane can be used as an alternative to propofol and sevoflurane for maintenance of anesthesia in patients undergoing transnasal trans-sphenoidal pituitary surgery for its excellent recovery profile after anesthesia.