Pierre Robin Sequence (PRS) consisting of micrognathia, glossoptosis and cleft palate present with airway obstruction and feeding difficulties with or without other congenital anomalies. These patients come into category of difficult ventilation and difficult intubation. We present a case report of a 3years old female child, weighing 9.5kg, suffering from PRS with right lacrimal sac abscess and history of recurrent failed intubation, feeding difficulty along with failure of development of speech was posted for endoscopic DCR. Thorough preoperative airway assessment was done using COPUR scale and NCCT neck for detail airway dimension. Use of silicone round mask and two hand jaw thrust were beneficial for ventilation of the child with receding chin. The spontaneous ventilation was maintained till the airway was secured by performing inhalational induction with Sevoflurane followed by intubation using paraglossal approach of direct laryngoscopy with Miller's blade 1 and uncuffed ETT no 4.PRS patients are at risk of postoperative airway obstruction and respiratory depression. Anticipating this catastrophe steroid was administered intra-operatively, use of long acting opioids was avoided and patient was kept under observation in PACU for 24 hours after extubation.

BACKGROUND: Osteopetrosis is a collective term used for a pathological condition with defective function of osteoclasts presented with range of sclerosing bone diseases along with skeletal, renal, haematological & neurological manifestation. It may be autosomal recessive (ARO), autosomal dominant (ADO) and X-linked. It presents with hydrocephalus, short stature and anaemia, involvement of ocular nerve or facial nerve. Hypocalcemia, tetany, seizures & secondary hypoparathyroidism is known to occur. CASE REPORT: Two patients of osteopetrosis were posted for orthopaedic surgery. Both patients were operated under combined spinal epidural anaesthesia. 2ml of 0.5%Bupivacaine+30mcg clonidine was given intrathecally & epidural supplementation was given with Bupivacaine 3 cc increments after two segment regression of sensory level. Postoperative analgesia was provided by epidural Bupivacaine 0.125% along with Inj. Tramadol 50 mg on patient's request. CONCLUSION: Even if administration of anesthesia is a challenge in patients of Osteopetrosis, regional anaesthesia can be given safely with proper preoperative preparation & intraoperative care. KEY WORDS: osteopetrosis, femur fracture, combined spinal & epidural anaesthesia INTRODUCTION: Osteopetrosis is a collective term used for a pathological condition with defective function of osteoclasts presented with range of sclerosing bone diseases along with skeletal, renal, haematological & neurological manifestation. It is classified as Infantile malignant or (ARO), Intermediate type or (ARO) , Adult onset or (ADO)&X-linked Osteopetrosis. ARO is a life threatening condition manifests in first few months with life span of 6 to 10 yrs present with seizures with normal Calcium levels, renal tubular acidosis, cerebral calcification, developmental delay, hypotonia, retinal atrophy & sensorineural deafness. ADO is type I and type II. Type I is associated with reduced number & size of osteoclasts & involvement of ocular nerve while type II is associated with proliferation of large & multinucleated osteoclasts, involvement of facial nerve , bony sclerosis, renal tubular acidosis & cerebral calcification. In X-linked Osteopetrosis severe immunodeficiency is observed with ectodermal changes. The difficulties faced by Anaesthetists are difficult intubation due to facial deformities, head & mandibular involvement cervicomedullery stenosis may lead to cord trauma during intubation difficult spinal & epidural anaesthesia due to scoliosis and short stature. Leucoerythroblastic anaemia, pancytopenia, thrombocytopenia leading to excessive bleeding

Background: Supraclavicular brachial plexus block is an excellent regional anaesthesia technique for upper extremity surgery. Bupivacaine is most commonly used local anaesthetic in peripheral nerve blocks. The cardiotoxicity of bupivacaine limits its use in large volumes necessitating the need for alternative drugs in upper extremity blocks. Levobupivacaine is a promising drug with less cardiodepressor activity. The basis for this study is to compare its sensory and motor blockade with that of bupivacaine. Methods: This study included 60 ASA grade | and || patients of both sex aged 18 years and above, weighing between 50-70 kg undergoing upper limb orthopaedic surgery. They were randomly allocated to group B (received 30 ml 0.5% bupivacaine) and group L (received 30 ml 0.5% levobupivacaine). Comparison was made regarding onset, duration and quality of sensory and motor blockade between the two groups. Results: Statistically significant difference was found in the onset of sensory and motor blockade between the two drugs with short latency in-group B. Conclusion: Levobupivacaine proves to be a comparable and better alternative to bupivacaine in supraclavicular brachial plexus block owing to its cardiostability.

Introduction: Tetanus is a disease caused by endotoxins, tetanolysin and tetanospasmin released from Clostridium tetani which affects motor inhibitory neurons. The challenge for anesthesiologist lies in control of autonomic dysfunction and muscle spasticity. Case Report: In this article we have discussed anesthetic management of a 5 year old boy with otogenic tetanus posted for removal of foreign body in left ear. He was admitted in infectious ward with trismus, fever, muscle spasm and difficulty in swallowing for last four days. He received intramuscular tetanus toxoid, intramuscular immunoglobulin 5000 IU as bolus followed by 2500 IU/day. Intravenous diazepam 6 mg at every three hours and intravenous cefixime was given. On second day of admission he was posted for removal of foreign body in left ear. Intravenous diazepam and fentanyl were given as premedication and sevoflurane, nitrous oxide and oxygen was used for general anesthesia. During surgery and in postoperative period he developed hypertension and tachycardia, was treated with intravenous labetolol. Conclusion:

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